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Background: The standard approach to subcutaneous defibrillator (S‐ICD) implantation often requires general anesthesia or anesthesiologist‐delivered deep sedation. Ultrasound‐guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anesthesia/analgesia and to reduce the need for sedation during S‐ICD implantation. In this pilot study, we compared the double‐block approach (SAPB + PSB) with the single‐block approach (SAPB only) and with the standard approach involving local anesthesia and sedation. Methods: We prospectively enrolled 22 patients undergoing S‐ICD implantation: in 10, the single‐block approach was adopted; in 12, the double‐block approach. As a control group, we retrospectively enrolled 14 consecutive patients who had undergone S‐ICD implantation under standard local anesthesia and sedation in the previous 6 months. Intra‐ and postprocedural data, including patient‐reported pain intensity, were collected and compared in the three study groups. Results: The double‐block approach was associated with a shorter procedure duration than the single‐block and standard approaches (63.3 ± 7.9 vs 70.1 ± 6.8 vs 76.9 ± 7.8 min; P <.05) and with a lower dose of local an aesthetic for infiltration (18.9 ± 1.7 vs 27.5 ± 4.6 vs 44.6 ± 4.0 cc; P <.001). Both the double‐ and single‐block approaches were associated with lower pain intensity at the device pocket and the lateral tunneling site (P <.05). The double‐block approach proved superior to the other two approaches in controlling intraoperative pain at the parasternal tunneling site (P <.05). Conclusions: In our study, SAPB combined with PSB was superior to SAPB alone and to the standard approach in controlling intraoperative pain during S‐ICD implantation. In addition, this approach resulted in shorter procedure durations. [ABSTRACT FROM AUTHOR]

The authors express comment on the American College of Clinical Pharmacy (ACCP) Statement that defines the qualifications of the candidates for residency. They explore the focus of the statement which points out the importance of experience and practice in various clinical areas during training. The authors recognize the advantage of the requirements since they serve as the best way to mutually address a higher level of readiness in residencies.

It is the position of the American College of Clinical Pharmacy ( ACCP) that formal postgraduate residency training, or equivalent experience, is required to enter direct patient care practice. Therefore, it is important to align professional degree educational outcomes with the knowledge, skills, and attitudes needed to enter residency training. This position statement addresses the outcomes necessary in the professional degree program curriculum to ensure the ability of pharmacy graduates to transition effectively into postgraduate year one residency training. Five key outcome areas are identified: communication, direct patient care, professionalism, research, and practice management. The position statement examines how performance in each of the five outcome areas should be addressed by professional degree programs. The ACCP believes that for the student to achieve the clinical proficiency necessary to enter residency training, the professional degree program should emphasize, assess, and provide adequate opportunities for students to practice: communication with patients, caregivers, and members of the health care team in direct patient care environments; provision of direct patient care in a wide variety of practice settings, especially those involving patient-centered, team-based care; professionalism under the supervision and guidance of faculty and preceptors who model and teach the traits of a health care professional; application of principles of research that engender an appreciation for the role of research and scholarship in one's professional development; and application of practice management, including documentation of direct patient care activities that affect drug-related outcomes. [ABSTRACT FROM AUTHOR]