services.mwanzoni.com/microbiology-for-the-mcat-dat.php Comic books have always drawn heavily in folklore in general and many fantasy books have been successfully adapted into the comics medium. To find more titles like Bone or a larger selection of manga, be sure to check out the young adult guide here. No 'N' titles available at this time! Home Where To Start? Join Taako the elf wizard, Merle the dwarf cleric, and Magnus the human warrior for an adventure they are poorly equipped to handle AT BEST, guided "guided" by their snarky DM, in a graphic novel that, like the smash-hit podcast it's based on, will tickle your funny bone, tug your heartstrings, and probably pants you if you give it half a chance.
With endearingly off-kilter storytelling from master goofballs Clint McElroy and the McElroy brothers, and vivid, adorable art by Carey Pietsch, The Adventure Zone: Here There be Gerblins is the comics equivalent of role-playing in your friend's basement at 2am, eating Cheetos and laughing your ass off as she rolls critical failure after critical failure. This book is recommended for teens and adults. After she is kidnapped by a lascivious baron, she turns herself into a moth and flees to the garden of a charming butterfly collector named Napoleon Bonaparte.
This book is recommended for older teens and adults. Shadow Moon gets out of jail only to discover his wife is dead. Defeated, broke, and uncertain where to go from here, he meets the mysterious Mr. Wednesday, who employs him to serve as his bodyguard--thrusting Shadow into a deadly world where ghosts of the past come back from the dead, and a god war is imminent. Allison Carter is a private detective. Her beat: the end of the world, or more accurately, preventing same.
With an attitude of "shoot first and the hell with the questions," she leads a life that would make other investigators give up. When a mysterious figure gets his hands on the Book of Keys, whose secrets can cause the destruction of the world, A is the only one who can stop him.
Her journey takes her through a world populated by zombie cops, machinegun toting imps, techno-wizards, closet trolls, demonic theme parks, other dimensions, Ultimate Darkness, and an undead ex-boyfriend. Anya could really use a friend. But her new BFF isn't kidding about the "Forever" part.
Of all the things Anya expected to find at the bottom of an old well, a new friend was not one of them. Falling down a well is bad enough, but Anya's normal life might actually be worse. She's embarrassed by her family, self-conscious about her body, and she's pretty much given up on fitting in at school. A new friend—even a ghost—is just what she needs. Or so she thinks. He refused to acquiesce to the editor's demands to change the story and pulled the book from them. He liked it so much, however, that he decided to rework it as an Adastra story shortly after undertaking the BWS: Storyteller series a few years ago.
Now, more than a decade after it was begun, it is finally in print. Adastra in Africa spotlights the young, exiled goddess traveling to an African village and striving to bring salvation to the famine-stricken area. It's a compelling tale of an outsider attempting to use her own non-traditional methods to help a defiantly proud people regain its vitality, without compromising the tribe's heritage and values.
This stand-alone graphic novel features some of the most beautifully intricate and graceful drawing of Windsor-Smith's legendary career. In this out of continuity tale, Black Canary infiltrated a gang of female criminals set to pull a dangerous heist at a Las Vegas casino one year ago. Its leader was skilled in hand-to-hand combat and with more than a passing interest in the occult, specifically black magic, one nasty customer. Rather than be taken by Canary or the law, she went to her death, vowing she would get revenge on Canary and her own former gang members.
Now, a year to the day later, death stalks those gang members, and Canary must turn to her friend Zatanna to help investigate. Illustrated and presented by one of the leading artists in modern fantasy, here are the great songs and folktales of the English, Irish, and Scottish traditions, re-imagined in sequential-art form, in collaboration with some of today's strongest fantasy writers. Introduced by award-winning editor and writer Terri Windling, and finished with full lyrics and discographies of the classic versions of these songs and tales, "The Book of Ballads" is an event in the worlds of fantasy and graphic storytelling alike.
Follow young Gully as she searches for her missing father, making powerful friends and deadlier enemies along the way. Alongside Knolan, Calibretto, and Garrison with a watchful eye on Red Monika , this unlikely troop band together to face the dangers that assail them on their quest. Whether gathered by fate or something more, destiny has made them A quartet of fallen mystics dubbed the "TrenchCoat Brigade" is introduced in this first collection of the adventures of Timothy Hunter. John Constantine, the Phantom Stranger, Dr. Occult, and Mister E take Hunter on a tour of the magical realms.
Along the way he's introduced to Vertigo's greatest practitioners of magic and must choose whether or not to join their ranks. Tim Hunter, destined to become Earth's greatest sorcerer, defends the realm of Faerie from the deadly manticore while trying to maintain a normal childhood. Is his real father the one-armed drunk in the front room or is he the man who can turn into a hawk? Is his mother dead and buried, or is she Titania, Queen of Faerie?
Plus, Death herself weighs in on the subject of identity. Consider the orchid: exotic, intoxicating and rare. Consider Black Orchid: a demigoddess in search of her own identity. The flowerlike result of a scientific experiment, the Black Orchid must reconcile her human memories with her botanical origins. An American graphic novel first! The complete page epic adventure from start to finish in one deluxe trade paperback. Three modern cartoon cousins get lost in a pre-technological valley, speanding a year there making new friends and out-running dangerous enemies. They learn about sacrifice and hardship in The Ghost Circles and finally discover their own true natures in the climatic journey to The Crown of Horns.
This book is recommended for all ages. Cairo interweaves the fates of a drug runner, a down-on-his-luck journalist, an American expatriate, a troubled young student, and an Israeli soldier as they race through bustling present-day Cairo to find an artifact of unimaginable power, one protected by a a dignified jinn and sought by a wrathful gangster-magician. But the vastness of Africa's legendary City of Victory extends into a spiritual realm--the Undernile--and even darker powers lurk there Over 80 of the best creators from every style and genre have contributed over 50 stories to this anthology featuring tales inspired by the songs of multi-platinum recording artist, Tori Amos!
Fed up with both civilization and mysticism, Conan travels to the infamous City of Thieves to take out his frustrations. When a bar fight uncovers the legend of the impregnable Tower of the Elephant, he becomes determined to rob it, setting out on a quest unlike any he's undertaken-one that will involve new comrades, sudden death, horrifying creatures, and gruesome unsettling fates for both gods and men. This volume collects issues 1— 4 of the smash-hit crossover!
In a tale spanning three eras in the lives of these classic characters, Conan and Red Sonja become comrades to take down a sorcerer-priest hell bent on creating a new age in Hyborian warfare! Conan and the Jewels of Gwahlur by P. Craig Russell Artist ; Robert E. A young woman, having made a string of bad choices, finds herself the pawn of mercenaries - one of which is Conan of Cimmeria.
As the former dancing girl poses as the dead oracle of a primitive cult, Conan puts his experience as a thief and a soldier together in pursuit of some of the most prized jewels in the world - the Teeth of Gwahlur! A tribute to Robert E. Howard's tenacious King Conan. Beleaguered by attempts at his crown and sickened by political maneuverings, Conan is the sort of king who takes matters into his own bloody hands.
In "The Sorrows of Akivasha," Lee fully paints and Truman fleshes out the sad plight of a seductive, centuries-old vampire from Robert E. Howard's only Conan novel, The Hour of the Dragon. Brutal battles on Pictish soil, scheming sorcerers, false prophets, a lust-filled vampire, and a little bit of humor -- this is an excellent introduction to Dark Horse's Conan universe for both entirely new fans and well-read, seasoned fans! A wizard has appeared in present-day New York! His name is Wizord, and he's here to save us all from dark magical forces bent on our destruction.
He's the best wizard of all time! The Essential Conan is a collection of the first 25 issues of the Conan the Barbarian comics released by Marvel back in the early seventies, adapting the works of Robert E. Chronicles of Conan Vol. From the turbulent seas to the deepest, darkest jungles, the barbarian Conan moves ever closer to his destiny as king and conqueror. Allied with the deadly she-pirate Belit, Conan journeys further into the most savage and untamed Hyborian lands, and into his own heart of darkness.
In the mid s following the colossal success of Conan the Barbarian, Roy Thomas helped expand the universe of Conan to showcase further stories and the talents of some of the comics industry's best with the equally popular Savage Sword of Conan magazine. Now, for the first time in over thirty years, these primal tales, featuring Robert E. Howard's most popular character, are available in this, the first in a series of massive trade paperbacks, collecting all Savage Sword Conan stories beginning with issue one.
The first book is the Dark Tower series. Now, in a comic book Roland's past is revealed! The second book in the Dark Tower series. Gunslinger Roland Deschain has seen the death of his lover Susan Delgado. And the Big Coffin Hunters who burned her at the stake are now in pursuit of Roland and his ka-tet Cuthbert and Alain. The friends are forced to flee into the desert with the deadly posse in hot pursuit Don't miss the next chapter in the saga of the Gunslinger whose quest for the Dark Tower will shake the foundation of reality itself!
Near death from an attack by Slow Mutants, Roland Deschain is taken in by a group of Sisters who specialize in anything but the healing arts. These hideous, corpse-like creatures known as the Little Sisters of Eluria have murder on their twisted minds. In his current, wounded condition, there's almost nothing the last gunslinger can do to prevent their tender mercies from taking hold.
It's the beginning of a new Dark Tower story arc featuring the fine pencils of Luke Ross, whose work on this story will astound you! When several children go missing in a small English town, the Dead Boy Detectives are on the case. A series of strange and unexpected twists takes them to Free Country, a place that dates back a millennium, where children never grow old and are free from the abuse and tyranny of adults.
But Free Country is failing, and what it needs is the strength of five innately powerful children — including the young sorcerer Timothy Hunter — to restore their uncanny world to what it once was. Demon Wars Vol. Corona may have been saved from the horrible power of the demon dactyl, but not all is safe Pony and Elbryan face continued peril from the corrupt church as well as the remnants of demonic servants that roam the land. Are they still empowered by the destroyed dactyl, or are they drawing strength from an even more sinister source?
But when he arrives at the Avatar's chambers, he finds his long-lost sister Liana. Doctor Strange Vol. Only Doctor Strange can protect our world from the darkness beyond! But every spell cast comes at a cost. What happens when Earth's Sorcerer Supreme falls behind on his tab? Find out as the good doctor wakes up somewhere very odd, nearly naked- with no spell books, no weapons and no memory of how he got there And as a new visitor to Strange's Sanctum Sanctorum learns one wrong door can lead to oblivion, a magic circle of Strange's friends and allies are about to face their greatest threat.
Dark forces are destroying everything mystical in the multiverse, and their sights are set on this dimension. Magic's days are numbered, and Doctor Strange is not ready! They've crossed the dimensions, purging each of all sorcery. Now the Empirikul are here. And with Earth's Master of the Mystic Arts weakened beyond measure, is there any chance of stopping them?
The Sorcerer is no longer Supreme, and he'll find himself at the mercy of the Imperator! With his magic destroyed and his world on the brink of disaster, are there any more tricks left up Strange's sleeves? Or failing that, how about some cool weapons? Plus: As the Empirikul wreak havoc on magic users across the Marvel Universe, discover Wong's ultimate sacrifice, watch Brother Voodoo make a stand, and meet a new player just as she's about to lose the game!
How did Stephen Strange become the Sorcerer Supreme — and how has he lost it all? In the present, Strange is on the brink of death, his magic nearly depleted. Sensing the Master of the Mystic Arts is at his weakest, his greatest foes will return from the shadows, ready to strike — starting with one of his oldest rivals, Baron Mordo! Doctor Strange and the Sorcerers Supreme Vol.
When an ancient evil threatens to unravel the fabric of reality, Doctor Strange must unite Sorcerers Supreme from across time to stem the coming darkness. But even a team of the greatest sorcerers history has ever known may not be enough! Not to mention Strange should watch his back, not all these Sorcerers have his best interests in mind. Doctor Stephen Strange embarks on the most important paranormal investigation of his career, as he sets out to solve an attempted murder--his own!
And with his most trusted friend also at death's door, Strange turns to an unexpected corner of the Marvel Universe to recruit a new ally. Dragonlance Chronicles Vol. A number of the Companions are taken captive by the dragon army Can Caramon, Tax and Tika find a way to escape the order of death that hangs over them? Will they survive the arrival of Takhisis, the dark queen responsible for the war they're fighting in? Plus: Tanis receives help in a desperate battle from a very unexpected source The first story introduces the young, pale, perky, and genuinely likable Death. One day in every century, Death walks the Earth to better understand those to whom she will be the final visitor.
Today is that day. As a young mortal girl named Didi, Death befriends a teenager and helps a year old homeless woman find her missing heart. What follows is a sincere musing on love, life and of course death. In the second story, a rising star of the music world wrestles with revealing her true sexual orientation just as her lover is lured into the realm of Death that Death herself should make an appearance.
A practical, honest, and intelligent story that illuminates "the miracle of death. This series is recommended for older teens and adults. Strange and Dr. Every year on Midsummer's Eve, Victor von Doom clashes with the forces of evil in a vain attempt to free his mother's soul from Hell. Only when Doctor Strange is finally convinced to join the fight, does the outcome have any hope of changing.
But first the unlikely allies must journey to Mephisto's infernal realm In a post-Fables world where magic abounds, it can be wielded for the greater good or used to plant the seeds of anarchy and terrorism. The Shadow Players are a global network of agents--both Fable and mundane--tasked with policing a newly enchanted world and protecting humanity from itself. Everafter features the return of series favorites Bo Peep, Peter Piper, Hansel, and Connor Wolf, as well as exciting new characters and a terrifying new villain! Everlast follows Derek Everlast, a man whose destiny in life is guiding others to a place of rebirth for mankind called Haven.
Following an instinct called the Nudge, bestowed on him by a higher power, Derek is guided to the next chosen human destined to survive, a little girl named Melissa. In a harrowing adventure, he must deliver her safely to Haven before the End of Days. Everlast tells a story of choice, love, friendship, and, most of all, survival.
The Wolfriders have escaped the prison of Blue Mountain, but have gone from the frying pan into the fire. The Palace of the High Ones calls to them, but as they journey, they are set upon by ferocious trolls who guard the relic. Now the elves tend their wounds in the lodges of the Go-Backs and wonder This book is recommended for young adults and up. The Wolfriders have settled into their new Holt in the Forbidden Grove. The tumult of the Quest is behind them, and new life has come to the tribe. All is peaceful until a Wolfrider child is kidnapped. The elves must once again confront Winnowill and her schemes -- but first they must get through the humans who worship the evil temptress.
Within the corridors of Blue Mountain, Winnowill has hatched her most ambitious plan ever -- to take her people away from the World of Two Moons and back to the stars. To accomplish this, she must be rid of the Wolfriders. As her human slaves and Cutter's tribe fights for its survival. Winnowill prepares her final, mind-boggling assault. When a savage creature known only as the Adversary conquered the fabled lands of legends and fairy tales, all of the infamous inhabitants of folklore were forced into exile.
Disguised among the normal citizens of modern-day New York, these magical characters have created their own peaceful and secret society within an exclusive luxury apartment building called Fabletown. But when Snow White's party-girl sister, Rose Red, is apparently murdered, it is up to Fabletown's sheriff, a reformed and pardoned Big Bad Wolf Bigby Wolf , to determine if the killer is Bluebeard, Rose's ex-lover and notorious wife killer, or Jack, her current live-in boyfriend and former beanstalk-climber.
Ever since they were driven from their homelands by the Adversary, the non-human Fables have been living on the Farm—a vast property in upstate New York that keeps them hidden from the prying eyes of the mundane world. But now, after hundreds of years of isolation, the Farm is seething with revolution, fanned by the inflammatory rhetoric of Goldilocks and the Three Little Pigs.
And when Snow White and her sister Rose Red stumble upon their plan to liberate the Homelands, the commissars of the Farm are ready to silence them—by any means necessary! This book is recommended for adults. In the Fables' world, there isn't a lot of happily-ever-after to go around. As refugees from the lands of make-believe, the Fables have been driven from their storybook realms and forced to blend in with our gritty, mundane reality. But that doesn't mean they don't have any room for romance—or the pain, betrayal and jealous rage that go along with it. In fact, love may be blooming between two of the most hard-bitten, no-nonsense Fables around.
But are they destined for happiness— or a quick and untimely death? Bill Willingham's runaway hit series FABLES continues its success in this fourth trade paperback, collecting issues and issue 22 will appear in a future collection and featuring the rise of a new threat to Fabletown. When Little Red Riding Hood suddenly walks through the gate between this world and the lost Fable Homelands, she's welcomed as a miraculous survivor by nearly everyone - everyone except her old nemesis, Bigby Wolf, who smells spying and subversion more than survival.
But will he be able to prove his case before disaster strikes? And how will it all affect Prince Charming's upstart campaign to become the new mayor of Fabletown? Fables is the hugely imaginative story of a group of fairy tale characters exiled from their mythical homelands and forced into a secret existence in modern-day America.
Exploring, amongst other tales, the strange story of Dog Company—involving the hair-raising escapades of Bigby Wolf during World War II and how he dealt with an underhanded Nazi experiment! Volume five of this superb Titan series continues to explore this surreal underworld created by scribe extraordinaire Bill Willingham. Collecting issues of writer Bill Willingham's Eisner Award-winning creation, Homelands follows Boy Blue on a mission of revenge as he uncovers the Adversary's true identity!
Plus, the two-part story of Jack's adventures in Hollywood and the one-shot story of Mowgli's return to Fabletown. This seventh volume of the popular Vertigo series also includes "The Ballad of Rodney and June," the 2-part story of forbidden love among the Adversary's wooden soldiers. Collecting issues of writer and creator Bill Willingham's award-winning Vertigo series, WOLVES also includes newly-created maps of Fabletown and the Homelands illustrated by Willingham and, as a special bonus, Willingham's complete script to the double-sized issue Pinocchio suffers seriously divided loyalties between his father, the evil Adversary, and his fellow Fable refugees in New York.
Plus, Bigby Wolf reluctantly decides it's finally time to square accounts with his long-estranged father, the North Wind, and makes a journey with Snow White and their kids to find him. Rose Red, sister of Snow White, has finally hit rock bottom. Does she stay there, or is it time to start the long, tortuous climb back up? The Farm is in chaos, as many factions compete to fill the void of her missing leadership.
The most harrowing epic since the inception of the series starts when Snow and Bigby's cub Therese receives a Christmas gift from an unknown admirer. This red plastic boat may hold the key to a deep, disturbing secret that will incite a series of soul-crushing events for the denizens of Fabletown. With Castle Dark now back in the hands of the Fables, mysteries both young and old begin to challenge the residents of Fabletown.
Bigby and Stinky set off from Fabletown in Rose Red's blood-fueled sports car to track down the two abducted cubs. Unfortunately for Snow White, besides suffering the trauma of having two of her cubs go missing, a long forgotten secret uncovered in Castle Dark threatens to sabotage her and Bigby's marriage. A flagship title of the Vertigo imprint of DC, this series tells the story of fairy tale characters exiled to the mundane world after fleeing from a mysterious conqueror known as the Adversary. Think "Once Upon a Time" but better and written over a decade before the show ever came out.
When Snow White's party-girl sister, Rose Red, is apparently murdered, it is up to Bigby, Fabletown's sheriff, and a reformed and pardoned Big Bad Wolf, to determine if the culprit is Bluebeard, Rose's ex-lover and notorious wife killer, or Jack, her current live-in boyfriend and former beanstalk-climber.
Then travel to upstate New York, where the non-human Fable characters have found refuge on a farm, miles from mankind. But all is not well on the farm — and a conspiracy to free them from the shackles of their perceived imprisonment may lead to a war that could wrest control of the Fables community away from Snow White. This series features mature content and is recommended for adults.
As Snow White slowly recovers from a bullet to the brain, she and Bigby spend a lot of time in each other's company.
But when they announce that they'll be vacationing together, all of Fabletown is shocked The twosome's sudden departure from New York City -- and the deadly peril they're about to fall into -- is surely no match for the ruthless enemy who's still lurking in the back woods. As the battle rages, we meet a mysterious woman in red, and learn why Snow White's deputy, Little Boy Blue, only plays the blues on his trumpet. In the aftermath of the Adversary's attack on Fabletown, this volume follows with the impending birth of Snow White and Bigby Wolf's children!
Meanwhile, Boy Blue goes on a mission of revenge, as he discovers the Adversary's true identity. Boy Blue continues on a mission of revenge as he uncovers the Adversary's true identity! Plus, the two part story of Jack's adventures in Hollywood and the one-shot story of Mowgli's return to Fabletown. The threat of the Adversary looms ever closer as the drums of war begins its steady beat. The Fables prepare for battle, but first they need to find their would-be commander: Bigby Wolf!
Preparation for war between Fabletown and the Empire begins! The Adversary calls a conference of the Imperial elite to decide what to do about Fabletown and Pinocchio has to face up to his divided loyalties between his friends and his family. Meanwhile, Bigby decides the time has come to confront his father, the North Wind, while the cubs learn more of their family and celebrate their birthday!
Plus, Burning Questions by the fans answered! Flycatcher is drawn into the spotlight as he discovers the startling truth about his own past as the Frog Prince. At the same time, he learns that the Adversary plans to destroy his foes once and for all. How can the meek Flycatcher stop this deadly foe? The final battle between the free Fables of the mundane world and the Empire occupying their former Homelands is here! The creatures of myth and fairytale lore have assembled together to finally face the Adversary and his hordes.
But victory will not come without a price—who will live and who will die for the fate of the Homelands? The exiled Jack of Fables reappears as the entire Fables world is threatened by the Literals - beings who could wipe out any Fable with a single penstroke. Meet Dunster Happ, the most important Fable you never knew. If our friends in exile at The Farm knew even a fragment of what humble Dunster knew, they'd be in a lot less trouble right now.
Happ's just one of a cast of thousands in this issue where we explore Mister Dark's past and how he ended up in that magical box in that faraway fortress so that two hard-luck mercenaries could come along one day and set him free. Mister Dark has risen again, more powerful than ever before. The Fables are down to their last defenses--looks like it's time for Super Fables!
Our beloved fairy tale characters shift into your favorite superheroes to take on evil. But what happens when the tights and capes are stored away? Bigby and Snow White's cubs try to move forward after learning a hard lesson about life and death. And the lovable, fan-favorite hero Bufkin the Flying Monkey gets into more trouble when he finally reaches his homeland of Oz. When Snow and Bigby's cub receives a Christmas gift from an unknown admirer, her ensuing journey into Toyland takes a turn for the terrible and Fabletown is left frantic.
Rose Red, as the human avatar of Hope, is inspired to gather her own knights and re-form the Round Table right on the Fables' farm. Who will be her new recruits? As she tries to pull everyone together, a certain dead man has left his remains on the coroner's table.
A new era begins as knights arrive from every corner of countless worlds--but is Snow White destined to bring it all crashing down? Acclaimed by critics and readers alike, these modern classics of comic book storytelling are now collected for the first time in a series of beautiful hardcover volumes. Traveling in Arabia as an Ambassador from the exiled Fables community, Snow White is captured by the local sultan who wants to marry her and then kill her. But the clever Snow attempts to charm the sultan instead by playing Scheherazade, telling him fantastic stories for a total of 1, nights.
Running the gamut from horror to dark intrigue to mercurial coming-of-age, Fables: Nights of Snowfall reveals the secret histories of familiar Fables characters through a series of compelling and visually illustrative tales. Fables - Cinderella Vol. When supernatural artifacts from the Homelands begin surfacing in the modern world, it falls to Cinderella, Fabletown's best kept and best dressed secret agent to stop the illegal trafficking. But can Cindy foil the dark plot before Fabletown and its hidden, exiled inhabitants are exposed once and for all?
And how does her long lost Fairy Godmother factor into the equation? Whether she's soaring through clouds, deep-sea diving, or cracking jaws, Cindy travels from Manhattan to Dubai and hooks up with a handsome, familiar accomplice who may be harboring secret motives of his own. Meanwhile, trouble brews back home in Fabletown when Cindy's overworked, underappreciated assistant decides to seize control of The Glass Slipper, Cindy's exclusive shoe boutique. Someone is killing sorcerers out on the Farm, and all signs point to Cinderella's archnemesis from the old days.
The only problem is, Cinderella has always believed that her nemesis has been dead for years. Come and hear of the terrible tale of Miss Finch, an exacting woman befallen by mystery and abduction deep under the streets of London! Join a group of friends, with the stern Miss Finch in tow, as they enter musty caverns for a subterranean circus spectacle called "The Theatre of Night's Dreaming. Following this first collection, Willingham will serve as a consultant on all story arcs and introduce new writers from other mediums to the FABLES mythos.
Rapunzel lives one of the most regimented lives in Fabletown, forced to maintain her rapidly growing hair lest her storybook origins be revealed. But when word of her long-lost children surface, she races across the sea to find them--and a former lover. When Nalayani seeks the help of the Maharaja to save her village from the Dhole, she uncovers a secret that could change the Fables Universe forever: the still alive and long-thought dead Prince Charming! Cinderella returns in an all-new epic! After an assassination attempt on Snow White, Cind is called back into service to unravel an age-old conspiracy that dates back to that fateful midnight ball!
Can Cind uncover the plot and prevent a massacre in Fabletown? In this new epic, refugees from Fabletown have returned to New York's Castle Dark, and Reynard, now able to shapeshift from fox to man, travels the mundane world to regale the animals with tales of his exploits, rubbing the other Fables' noses in his good fortune. Frustration at their restriction to the Farm threatens to become a issue once more! Can the animals find a way out of their situation? A cross between Indiana Jones and pulp heroes of old like Doc Savage, this is a great read!
After a tragic encounter with an artifact known as "The Dreamstone," infamous treasure hunter Fabian Gray was possessed by five literary ghosts and has been granted access to their unique abilities which he uses to try and find his missing sister while discovering more about his new powers. On their perilous journey they'll encounter pirates and a dark shadow from Fabian's past. The critically acclaimed literary pulp adventure continues! Fabian Gray journeys to Eastern Europe on a quest to save his closest ally while battling his own inner-demons.
Wilde's tales are adapted into a comic book format and use fairy tale elements and Christian symbolism. Comprised of the initial six issues of the graphic series, this is the first volume in what is sure to be one of the most coveted collaborations of the year. Winter is coming. There his family dwells in peace and comfort: his proud wife, Catelyn; his sons Robb, Brandon, and Rickon; his daughters Sansa and Arya; and his bastard son, Jon Snow.
Far to the north, behind the towering Wall, lie savage Wildings and worse—unnatural things relegated to myth during the centuries-long summer, but proving all too real and all too deadly in the turning of the season. A Game of Thrones Vol. Such is the stern motto of House Stark, the northernmost of the fiefdoms that owe allegiance to King Robert Baratheon in far-off King's Landing. There Eddard Stark of Winterfell rules in Robert's name. Far to the north, behind the towering Wall, lie savage Wildings and worse--unnatural things relegated to myth during the centuries-long summer, but proving all too real and all too deadly in the turning of the season.
Yet a more immediate threat lurks to the south, where Jon Arryn, the Hand of the King, has died under mysterious circumstances. Now Robert is riding north to Winterfell, bringing his queen, the lovely but cold Cersei, his son, the cruel, vainglorious Prince Joffrey, and the queen's brothers Jamie and Tyrion of the powerful and wealthy House Lannister--the first a swordsman without equal, the second a dwarf whose stunted stature belies a brilliant mind. All are heading for Winterfell and a fateful encounter that will change the course of kingdoms.
Meanwhile, across the Narrow Sea, Prince Viserys, heir of the fallen House Targaryen, which once ruled all of Westeros, schemes to reclaim the throne with an army of barbarian Dothraki--whose loyalty he will purchase in the only coin left to him: his beautiful yet innocent sister, Daenerys. Others are hidden in the shadows. Still others wear the smiling mask of friends. But all are deadly, as Eddard is about to discover. Nor is the enmity between Eddard and the Lannister siblings the sole source of friction between these powerful noble families.
Now he seeks out his father, his restless thoughts bent on revenge. While across the Narrow Sea, Daenerys Targaryen, wed to the great Dothraki warlord Khal Drogo, and pregnant with his child—a son prophesied to conquer the world—will see her own destiny take an unforeseen turn. Martin; Ben Avery; Mike S. In this prequel story to George R. Dubbing himself "Ser Duncan the Tall," the Hedge Knight sets forth to the tourney at Ashford Meadow in search of fame, glory, and the honor of upholding his oath as a knight of the Seven Kingdoms. Unfortunately for him, the world isn't ready for a knight who keeps his oaths, and his chivalrous methods could be the very cause of his demise.
This book follows the adventures of Ser Duncan and his squire, Egg, as they quest for honor and glory in the Seven Kingdoms. After the deaths, surprises and heroics in The Hedge Knight, Dunk and Egg continue their journey in search of the fair puppeteer Tanselle. Along the way, the elderly knight Ser Eustace takes both men under his charge, alongside another knight- and this one promises trouble. Peace is ever elusive for Dunk and Egg. As they are soon embroiled in the schemes of local nobility, while a darker, greater thread threatens to unravel long-held truths of the Battle of Redgrass Field.
Imagine Garth Hale's surprise when he's accidentally zapped to the spirit world by Frank Gallows, a washed-out ghost wrangler. Suddenly Garth finds he has powers the ghosts don't have, and he's stuck in a world run by the evil ruler of Ghostopolis, who would use Garth's newfound abilities to rule the ghostly kingdom. When Garth meets Cecil, his grandfather's ghost, the two search for a way to get Garth back home, and nearly lose hope until Frank Gallows shows up to fix his mistake.
In the Fall of , as the nation gallops into war, a politically active teenage girl named Sun lives, loves and dreams in a small California town named Greendale. Sun's always been different. There's been talk that the women in her family have all had a preternatural communion with nature. And when a Stranger comes to town — a character whose presence causes Greendale to, well, go to hell — she'll find herself on a journey both mystical and mythical.
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Written by children's fiction author, Christopher Edge. This edition includes illustrations, preliminary notes, reading lists including websites and classroom notes. This edition includes illustrations, preliminary notes, reading lists and classroom notes. Demographic results include time in practice average 5. Qualitative assessment of CMM definitions demonstrated pharmacists understand the comprehensive nature of the care process. Further refinement of implementation is needed to increase understanding and utilization of the care process.
Pharmacist collaboration to increase antimicrobial stewardship in the treatment of urinary tract infections in the primary care setting Keaton Crockett, Pharm. In published literature, there is a lack of studies involving antimicrobial stewardship efforts by pharmacists directed at urine cultures in the primary care setting. Secondary objectives included the rate of interventions, rates of different empiric antibiotics prescribed, average antibiotic duration, and pharmacist time spent.
The average duration of empiric therapy was 7 days during both time periods. The average time spent by pharmacists performing chart review and making interventions was Impact of a pharmacist to pharmacist transitions of care initiative Ashley Thomas, Pharm. Multiple research initiatives have highlighted the value of including a pharmacist in the discharge process to prevent medication errors and readmissions. Furthermore, studies have also shown the benefit of utilizing a pharmacist on the outpatient side to aid in these transitions and prevent readmissions.
However, no study to date has evaluated the benefit and impact on readmission rates by implementing an initiative that leverages pharmacist presence in both settings. Manual chart review was conducted to quantify primary and secondary endpoints. Index readmission rates were 3. Candidate 2 , Sara Dugan, Pharm. Candidate 2 , Dankesh Joshi, Pharm.
Candidate 2 , Cynthia King, Pharm. Candidate 2 , Philip King, Pharm. Candidate 2 , Prabodh Sadana, Ph. Candidate 2 , Autumn Walkerly, Pharm. Visits involving pregnant patients were excluded. However, these prescribing rates are much lower than expected, especially in Black and Hispanic patients. These observations signify opportunities to improve the quality of care for patients who are at risk for major ASCVD events in the United States.
Hyperglycemia has been independently associated with negative outcomes for patients undergoing chemotherapy. The general medical care for patients with diabetes and cancer often falls to the primary care provider PCP , however studies defining the transition of patients from oncology to primary care are lacking.
After referral approval, patients were followed by CPS until individualized glycemic goals were met, and were compared to a control group of patients who started chemotherapy the year prior. Baseline characteristics were similar except that intervention patients were more likely to be male and less likely to have dexamethasone 20 mg or more per week prescribed. Most patients were discharged due to meeting glycemic targets. The weekly dose of GC did not appear to affect variations in glycemic control. While there was an increase in call volume for the CPS, the service led to decreased calls to oncology and primary care providers.
Clinical inertia amongst healthcare providers in diabetes management Sara Lingow, Pharm.
One study demonstrated less clinical inertia when specialists managed diabetes vs. Limited literature is available evaluating clinical inertia between pharmacists and other healthcare providers in diabetes management. Diabetes care was managed by a pharmacist or primary care provider. The primary outcome compares the rate of treatment intensification between groups at four months, measured by addition of a medicine or a dose increase. Secondary outcomes include the change in subsequent A1c, number of contacts, and a subgroup analysis based on baseline A1c and comorbidities.
Baseline A1c was similar between groups, while a higher percentage of patients in the pharmacist group were obese with comorbidities. Pharmacists had four patient contacts while primary care providers had one patient contact. This demonstrates the advantage of pharmacist involvement in diabetes care, particularly regarding intensification of insulin therapy.
Evaluation of an ambulatory transitions of care pharmacist service for high risk patients Kellie Kippes, Pharm. Average age was 60 years SD CMR recipients had 0. An average of 4. A provider survey to assess the expansion of clinical pharmacy services as part of the comprehensive primary care initiative Lisa Beckett, Pharm. In order to assess the perceived impact of this expansion, a provider survey was conducted.
Clinic leadership was notified of the survey and encouraged survey completion, while clinic pharmacists were excluded from the distribution and collection process. RESULTS: Surveyed providers strongly agreed that clinical pharmacists improve the quality, safety, value, and efficiency of patient care. When asked about specific clinical pharmacy services, the majority of respondents ranked them as very important, with collaborative disease management, high risk medication use in the elderly, and drug information consults as the most highly ranked services.
These results should be used to inform the further expansion of clinical pharmacy services in primary care. Developing and validating a measure to assess progress and success with implementation of a pharmacy service to optimize medication use Melanie Livet, Ph. Sorensen, Pharm. Assessment of chronic disease management among patients with diabetes and coronary artery disease receiving care in a cardiology clinic Scott Pearson, Pharm. It is unclear if these comorbidities are adequately managed among patients established in a cardiology clinic.
Secondary outcomes included additional measures of care quality and covariates predicting higher quality measure achievement. Quality measures were assessed using descriptive statistics. Women were less likely than men to achieve at least four of the five measures adjusted odds ratio [OR], 0.
Patients with two or more primary care provider PCP visits within the past year were more likely to achieve at least four measures compared to patients with less than two PCP visits adjusted OR, 2. New patients presenting with uncontrolled hypertension were included. Patients were matched between groups according to gender, baseline SBP, and history of cardiovascular disease.
Baseline characteristics were similar between groups except the standard care group was slightly older than the PPCCM group Studies are warranted to prospectively evaluate the benefit of these models on cardiovascular outcomes. Pharmacotherapeutic approaches to management of type 2 diabetes: a retrospective study of clinical pharmacist management versus usual care in a federally qualified health center Emanuela Mooney, Pharm. Pharm, M. Pharm 3 , Edith A. Nutescu, Pharm. Martin, Pharm.
Primary care providers PCPs at the authors' institution have low HCV screening rates among patients born between and Knowledge, perceived barriers, and facilitators were also assessed. Survey items were reviewed by authors and physicians at the institution for face validity and updates were made based on feedback. Email addresses of PCPs were obtained from administrators. Survey links were emailed to PCPs at three primary care locations within the academic medical center.
Lack of time was the most common barrier reported, and an electronic health record EHR prompt was the most common facilitator requested to aid in HCV screening. PCPs identified barriers of time, knowledge, and training, yet perceived primary care as an appropriate venue for HCV screening. However, strong contention regarding prediabetes and diabetes prevention exists among clinicians.
Data collection and analysis occurred in Improved adherence to a controlled substance agreement policy: an interprofessional approach Insaf Mohammad, Pharm.
Although guidelines recommend measures such as controlled substance agreements CSAs to attenuate risks, adherence to these practices remains inadequately evaluated. Furthermore, best practices to promote use of and adherence to CSAs are undefined. In the first cycle, the clinic pharmacist identified patients meeting policy criteria and educated medical residents, providers, and staff to ensure CSAs were discussed and signed during patient visits.
The outcome was percentage of signed CSAs. MedCalc was used for statistical analysis. Patients are frequently being switched to Basaglar, often due to insurance coverage. Secondary outcomes included change in HbA1c and weight. Mean basal insulin dose was Weight based dosing changed from 0. There was no difference seen in weight Clinicians should monitor blood glucose closely during basal insulin transition.
Falter, Pharm. Patients were excluded if they had a diagnosis of asthma. Patients were categorized into one of four treatment groups based upon the GOLD guidelines. Prescribing habits were then compared to guideline recommendations. Across all GOLD groups, appropriateness of prescribing increased from Data showed a lack of alignment to this standard at our practice, which is noted nationally. Assessing barriers to prescribing naloxone at a primary care center Tamara Malm, Pharm. PCPs were given paper surveys to capture attitudes regarding naloxone.
The primary outcome is the rate of and barriers to naloxone prescribing amongst PCPs at this facility.
Average prescribed MME was mg range 60 — 1,mg. Valid naloxone prescriptions were present for 8 patients 9. Two PCPs could identify the appropriate routes of naloxone administration. PCPs are a valuable resource for increasing patient naloxone education, and expanding naloxone access. In collaboration with the provider, the clinical pharmacist reviews medications for appropriateness, assesses adherence, recommends medication changes and provides education.
Readmission rates for patients seen by the pharmacist was 8. The only significant independent predictor of readmission was number of comorbidities adjusted odds ratio 1. Results were similar when readmissions for same reason, or for a different reason, were excluded. Innovative and collaborative MR approaches must be explored to identify best practices that attenuate risks.
Descriptive statistics were used. Comparing statin prescribing rates in eligible HIV vs. Reliability and validity of a patient responsiveness survey for comprehensive medication management Carrie Blanchard, Pharm. While measures of patient satisfaction for pharmacy services exist, no surveys have set out to measure patient responsiveness comprehensively. METHODS: A multiphase development process was used including: 1 literature search and item generation, 2 content validity, 3 pilot of the survey, and 4 reliability testing and construct validation.
Reliability testing indicated Cronbach's alpha to be 0. An exploratory factor analysis EFA was conducted. Based on analysis, a single factor explained In addition, patient responsiveness accounted for Future iterations of the survey should include additional factors believed to impact patient responsiveness, such as social determinants of health. Hons , M. Azzopardi, BPharm. Characterization of thrombocytopenia using a low dose heparin anticoagulation protocol for Impella CP devices in cardiogenic shock Andrea Sikora Newsome, Pharm.
Data regarding purge solutions is limited to case reports and one retrospective review of 12 patients using a different purge solution. Data collection included patient demographic information, duration of percutaneous LVAD support, components and concentrations of purge solution, coagulation laboratory values, systemic anticoagulation, and adverse events. The median absolute reduction in platelet count was 86 IQR The median percentage reduction in platelet count was No device thrombosis was observed.
This evaluation observed a consistent platelet reduction with the use of LVAD for cardiogenic shock but with a rate of HIT similar to other patient populations. The role of desmopressin as a blood conservation agent in select patients undergoing cardiac surgery Emily Moose, Pharm.
Patients were excluded for uremia, the presence of von Willebrand disease or hemophilia A, existing or prior history of hyponatremia, contraindication or hypersensitivity to DDAVP, or if anticoagulation or antiplatelet therapies were not held appropriately prior to surgery. In both arms, rates of acute renal failure, hyponatremia, transfusion requirements, and recombinant factor VIIa use were evaluated postoperatively. There was no difference in factor VIIa use, the rates of renal failure, and hyponatremia between the groups. DDAVP may have a role in cardiac surgery in patients with aortic stenosis, but additional research is needed for validation.
Optimal medical therapy prescribing patterns and disparities identified in patients with acute coronary syndromes Ashley N. Fox, Pharm. Skrepnek, Ph. Miller, Pharm. Schwier, Pharm. A regimen of 5 agents, or optimal medical therapy OMT is recommended by guidelines. Due to significant mortality of CHD in Oklahoma, research on OMT prescribing is warranted to improve practices and identify disparities.
Raised there as Hera's champion, he will travel with his adopted sister, Alice, legacy of Hecate and Hestia's champion, and save Olympus from. Images for the champion of hestia (the epic of alice book 1). The Dressmaker's Secret (The Chronicles of Alice and Ivy Book 1 Editorial Reviews. From the.
The primary endpoint was percentage of OMT prescribed. Demographics, presentation, and management were recorded. Medications were obtained from discharge documentation, and the medical record was screened for contraindications. All variables were analyzed independently, controlling for other variables.
Development of quality projects to improve prescribing should focus on at risk populations. Does body mass index influence warfarin dosing requirements? Evidence supporting effect of body mass index BMI on maintenance doses of warfarin and anticoagulation control is contradicting. METHODS: Adult patients receiving stable doses of warfarin, defined as having a therapeutic INR without a change in warfarin dose for at least 6 weeks, and attending ambulatory anticoagulation clinic in a tertiary hospital in Qatar, over one year period were included. Relevant data were collected through electronic chart review.
TTR was calculated using Rosendaal method. BMI ranged between No thrombotic events were detected. No correlation was observed between BMI and anticoagulation control. There were significant improvements in mean LVEF Nine percent discontinued therapy. Though many patients experienced an adverse effect, it often did not lead to discontinuation.
Comparison of preventive cardiovascular pharmacotherapy in surgical versus percutaneous coronary revascularization Arden Barry, BSc, BSc Pharm , Pharm. Paul's Hospital in Vancouver, Canada. Comorbidities were similar between groups. Directions to best achieve this is mixed. It is generally recommended to check BP readings at home twice daily and to check multiple readings each time 2 or 3 readings for several days. It is also recommended to discard the first day or the first of each triplicate readings. The first reading of each triplicate is discarded when averaging the overall home BP.
However, uptake in practice is variable, and studies have shown DOAC dosing may be inconsistent with manufacturer labeling. The primary outcome was percentage of patients prescribed a DOAC apixaban, dabigatran, edoxaban, rivaroxaban on discharge. Secondary outcomes included patient characteristics associated with DOAC versus warfarin use and percentage of patients prescribed the correct DOAC dose. Of the patients prescribed a DOAC, approximately one out of 10 did not receive the correct dose.
McGregor, Ph. All patients who filled a prescription for amiodarone in were identified for review. Patients actively followed by an outside provider, under hospice care, no longer taking amiodarone were excluded. If any monitoring parameters were determined to be missing, pharmacists would place orders directly or alert the appropriate provider.
Descriptive statistics were used to quantify the number and types of pharmacist interventions. A total of interventions have been recommended so far. Candidate 1 , Ian B. Hollis, Pharm. Deyo, Pharm. However, African Americans AA comprised only 5. The primary endpoint, achievement of target dose, and secondary endpoint, pharmacist impact on achieving target dose, were analyzed using the Chi Square test.
Time to achieve target dose and number of clinic visits required were analyzed using the Mann Whitney test. There was no significant difference between the percentage of AA Of patients receiving pharmacist care, Predicting bleeding and thrombosis complications in patients with continuous flow left ventricular assist devices Kyle Zacholski, Pharm. Candidate 3 , Aaron Cook, Pharm. It is unknown whether these tools are predictive in patients with LVADs.
All patients who received an LVAD within the study period were eligible for inclusion. The primary endpoint was the incidence of bleeding or thrombosis events within one year from implantation. Baseline risk model scores were calculated at time of LVAD implantation. A receiver operator characteristic ROC curve analysis was performed to evaluate the accuracy of the risk models to predict an event. None of the models had strong positive predictive value, suggesting that a better risk model is needed to predict bleeding and thrombotic events in these patients.
Lam, Pharm. Faulkenberg, Pharm. Bradley Williams, Pharm. This study will compare the use of captopril vs. Does inpatient oral vasodilator selection affect chronic therapies prescribed at discharge? The primary endpoint is time to SNP discontinuation after initiation of oral vasodilator. Secondary outcomes include ICU and hospital length of stay LOS , vasodilator prescribed at discharge, mortality and rehospitalization at one year post discharge. Time to SNP discontinuation Vasodilator selection during acute care may impact agent selection during chronic care, which may have implications on mortality.
Assessment of direct oral anticoagulant use for initial treatment of venous thromboembolism Carrie Oliphant, Pharm. March, Pharm. The primary outcome was treatment guideline adherence DOAC use at discharge. An additional analysis in the warfarin group was performed to identify potential barriers to prescribing DOAC therapy. Length of stay in the DOAC arm was significantly shorter compared to warfarin 2. Appropriate DOAC dosing was observed in All instances of incorrect DOAC dosing was due to under dosing.
Evaluation of heart failure transitions of care via distance health technology Ramone Boyd, Pharm. Candidate 4 , Daniel Lewis, Pharm. Mono versus dual antiplatelet therapy for secondary stroke prevention: a study focused on the African American population Amir Zaki, Pharm. Candidate 1 , Amne Borghol, Pharm. Candidate 1 , Alison Neuliep, Pharm. Candidate 1 , Ahmed Zaki, Pharm. Candidate 1 , Bree Bergeron, Pharm. Canddiate 1 , Mikee Castro, Pharm. Statistical analyses were performed using SPSS version Based on the outcomes between the monotherapy versus dual therapy, there was no significant difference in recurrent stroke and mortality.
There was a nearly significant higher bleeding event associated with dual therapy of 6. There is a need for more studies to evaluate the benefits of dual therapy in ischemic stroke patients and specifically in the African American population. It is unclear if racial differences in antihypertensive medication responses or pharmacogenetic variants that have different frequencies by ancestral groups, contribute to this disparity.
METHODS: We analyzed 1, participants with treated hypertension who reported taking all of their antihypertensive medications in the previous 24 hours at Exam 1. We calculated adjusted prevalence ratios PR for BP control associated with the 3 upper quartiles, separately, versus the lowest quartile of WAA. The lack of association between genetic ancestry and BP control may indicate differences in clinical inertia and social, cultural or environment factors.
Risk assessment of prescribing errors on medical prescriptions in Malta and Germany Jeffrey I. Kupka, R. Germany , Pharm. Hons Lond. Pharm Hons , M. Clinical Pharmacy , Ph. A risk assessment of errors arising from prescriptions in Malta and Germany was undertaken. Two questionnaires, one for physicians and one for pharmacists were developed and validated by 16 experts.
Prescribing errors due to illegible handwriting RPN of 6. Physicians and pharmacists in Germany rated the continuing prescriptions as their highest risk with a score of 5. In Malta, the physician's handwriting is viewed as the main source of prescribing errors. This error is not an issue in Germany as prescriptions are issued electronically. Risk minimisation strategies to address these risks include the use of electronic software. Expanding adolescent contraceptive access to pharmacies: predictors of adolescent willingness to utilize pharmacist prescribing Ashley Meredith, Pharm.
Most restrict prescribing to adults. Few data examine adolescent acceptability of pharmacist prescribing. Participants completed a demographic, behavioral, and health survey, including 2 items assessing acceptability of pharmacist prescribing and whether acceptability changes when they were made aware that counseling from a pharmacist was part of the protocol. A screening checklist for potential contraindications to contraception per CDC Medical Eligibility Criteria was completed. Bivariate analysis and multivariate logistic regression examined the effects of age, race, insurance, chronic illness, presence of a medical contraindication, sexual experience, perceived risk of pregnancy, and birth control use on acceptability.
No other characteristic was found to be statistically significant in logistic regression. Results were not influenced by presence of a potential contraindication, sexual experience, and use of birth control. These data illustrate a need for additional outreach to adolescents related to pharmacy access, and emphasize the need for a rigorous screening process by pharmacists. Convenience sampling with geographical quota was employed to recruit respondents during January to March , from across Singapore's five Urban Redevelopment Authority planning regions based on geographical distribution of the population.
High accessibility, comprehensive hours, and drug expertise make community pharmacists excellent candidates to serve as travel health experts. Patients were excluded from the study if they were pregnant or immunocompromised. Secondary outcomes evaluated patient satisfaction as well as perceived monetary value of the service. A questionnaire was administered to study participants before and after the consultation. Smithburger, Pharm. This is especially important following extended MICU stays, as likelihood of inappropriate continuation increases with increased length of stay.
Incidence of neurobehavioral side effects associated with levetiracetam and phenytoin in traumatic brain injury: a retrospective cohort study Tian Yaw, Pharm. Patients were excluded if the length of stay was less than 24 hours due to either death or transfer or had active transfer or hospice orders at 24 hours. Future studies will focus on generalizability to other institutions and relationship to pharmacist activity. Evaluation of continuation rate of antipsychotics for delirium treatment upon discharge from the intensive care unit: a retrospective chart review Deepali Dixit, Pharm.
Prevention of chronic pain with the use of continuous infusion ketamine in acute trauma related pain Cara Coleman, Pharm. Ketamine may reduce need for opioid therapy and subsequent transition to CP given its unique pharmacodynamic activity in pain signaling. The primary endpoint was to determine if there was a difference in CP development, defined as pain requiring treatment with opioids at 3 months following hospital discharge, between patients receiving ketamine KG versus standard of care SOC.
Secondary endpoints analyzed differences in opioid requirements represented as oral morphine equivalents [OME] within the KG based on whether therapy was initiated within or after 72 hours of admission and the total amount of ketamine received, separated into quartiles. There was no difference in CP development between groups KG, Getting code smart sepsis medical alert response team : multidisciplinary interventions to improve sepsis bundle performance are associated with decreased mortality Monica Shah, Pharm.
Koyuki Azumaya English version, voice. Of these matters, beginning where you want, O daughter of Zeus, tell to us. And the Sea Will Tell reconstructs the events and subsequent trial of a riveting true murder mystery, and probes into the dark heart of a serpentine scenario of death. But the closer she gets to the truth, the more danger shadows her every move. But every spell cast comes at a cost. How much of Luci Christian's work have you seen? Rita English version, voice.
Scott Mathis, Pharm. Since the SSC's first guidelines were released, sepsis mortality has decreased overall. Implementation of bundle elements remains low due to many barriers including recognition, staffing, and care organization. Evaluation of prophylactic heparin dosage on the incidence of venous thromboembolism, bleeding, and thrombocytopenia in critically ill patients receiving mechanical ventilation Paul Reynolds, Pharm.
Higher dosing has been proposed to lower incidence of VTE in these patients, but this remains unstudied. Exclusion criteria were: switching heparin dosage, thrombolytics, orthopedics, trauma, or death before 2 days. The primary outcome was development VTE after day 2. Key secondary outcomes included major bleeding, thrombocytopenia, and mortality. VTE after day 2 occurred in 6. There were no differences in hospital mortality Little data exist evaluating incidence and risk factors for accumulation.
Univariate and multivariate logistic regressions were performed for factors associated with detectable concentrations and acute kidney injury AKI. Differences between groups were age DC, Dose reduction may be necessary in these patients to avoid potential harm. The effect of obesity on vancomycin serum concentrations in patients on continuous venovenous hemofiltration Vincent Soriano, Pharm. Critical illness, obesity, and use of continuous venovenous hemofiltration CVVH significantly affect its clearance. Attainment of goal trough concentration has been associated with improved clinical outcomes.
An optimal dosing regimen has not been established in the above patient population. METHODS: Patients were included if they were 18 years of age or older, received at least 48 hours of vancomycin therapy, adhered to our institutional vancomycin dosing protocol, and had a serum vancomycin trough concentration drawn prior to the third or fourth dose. Given the small sample size and study limitations, further studies are required to validate these findings and to explore its potential clinical implications.
Vasopressin dosing protocols may result in disparate use in obese patients Susan Smith, Pharm. We hypothesized that dosing protocols would result in earlier initiation of vasopressin in obese patients. The primary outcome was time to vasopressin initiation. The total duration of vasopressors and the incidence of hospital mortality were similar between groups.
This unintended effect has unknown clinical significance.
Rifaximin for the treatment of septic shock: targeting endotoxemia Jane Lee, Pharm. Candidate 2 , Nithya Abraham, Pharm. Candidate 2 , Justin Kinney, Pharm. Rifaximin, an antibiotic normally used for traveler's diarrhea and hepatic encephalopathy, is associated with a reduction in endotoxemia; especially in patients with cirrhosis. However, limited evidence exists exploring the effect rifaximin may have in septic patients. Pregnant patients were excluded. Lastly, we wanted to compare the same outcomes in patients with cirrhosis. Statistical analyses were conducted with SPSS, version The rifaximin group had longer lengths of stay in both the ICU However, patients with cirrhosis showed improved ICU survival with rifaximin use.
Evaluation of dexmedetomidine for alcohol withdrawal syndrome with concomitant benzodiazepine treatment on length of stay David Quach, Pharm. The primary endpoint of the study was ICU and total hospital length of stay. The secondary endpoints included length of dexmedetomidine therapy, mortality, delirium and agitation rates, hemodynamic instability, respiratory depression rates, and mechanical ventilation status. The ICU length of stay was higher in the dexmedetomidine group The mechanical ventilation rate was significantly higher in the dexmedetomidine group compared to the benzodiazepine group It is worthy to note that the study was a retrospective review with the potential limitations of patient characteristic differences that play an unknown role in patient severity between the two groups.
Further research is needed to evaluate clinically significant outcomes pertaining to the safety and efficacy of dexmedetomidine as an adjunctive treatment in this patient population. Korobey, Pharm. At this time there is no clear evidence that any one agent results in better outcomes. Since duration of status epilepticus is one of the strongest predictors of morbidity and mortality, the ability to achieve resolution of status epilepticus rapidly is imperative.
Louis following benzodiazepine treatment for SE were included. The primary outcome was the incidence of SE resolution after one dose of levetiracetam or fosphenytoin. Incidence of SE resolution was similar between groups The most commonly used benzodiazepine was lorazepam, with similar average dosing between groups 2. Larger, prospective studies are needed to better evaluate differences in patient outcomes.
The dosing of second therapy phase agents for SE at this institution can be further optimized to ensure appropriate treatment. Eleven patients 2. One patient in each group was diagnosed with C. Patients with septic shock often have prolonged ICU stays due to persistent hypotension requiring treatment with IV vasopressors. A recent retrospective study identified midodrine could potentially wean vasopressors off sooner and shorten ICU stays in septic shock patients. Patients were excluded if midodrine was discontinued before vasopressors. RESULTS: patients were included total patients screened ; 60 patients received midodrine plus vasopressor therapy compared to 50 patients who received vasopressor therapy alone.
There was no difference in ICU survival However, the patients who received midodrine had improved ICU mortality. Perceptions of pharmacists regarding the cost containment strategies and proper use of vasopressin in septic shock Drayton Hammond, Pharm. Rech, Pharm. Personett, Pharm. The cost of vasopressin continues to rise, which may affect opinions and institutional initiatives. MeNemar's test was used to compare vasopressin use with and without cost considerations.
STATA v. At institutions that implemented an initiative, more respondents indicated vasopressin was initiated at 0. When vasopressin cost was considered, pharmacists recommended its use less frequently in multiple clinical scenarios that are grey areas. GCS was documented on days 1, 3, 5, and 7 after sedative drips discontinued, and discharge.
A prospective study is warranted to determine optimal timing and whether a combination is superior to amantadine alone.
Therapeutic drug monitoring of amikacin and augmented renal clearance in critically ill pediatric patients Leslie Escobar, Pharm. Augmented renal clearance ARC has been slightly described. Therapeutic drug monitoring TDM of amikacin using one level normally trough does not provide enough information about the impact of ARC on amikacin plasma concentrations. Neonates and patients in any renal replacement therapy were excluded. GraphPad Prism 7.
Median peak and C6 amikacin concentration were Also, they obtained significant lower amikacin plasma levels compared with patients with no ARC Cpeak: 21 vs A C6 sampling could be more appropriate than trough level to observe ARC for dose adjustment in these patients.