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Program Chairman:
Mohammad Sharifzadeh, Ph.D.
Dean of the TUMS School of Pharmacy
Program Directors:
Mojtaba Mojtahedzadeh, Pharm.D.
Tehran University of Medical Sciences,
Tehran, Iran
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Description of the Fellowship Program
A. Overview
The critical care pharmacotherapy fellowship program, offered by School of Pharmacy at Tehran University of Medical Sciences (TUMS) and Sina Hospital, is a new program whose primary goal is to provide ICU pharmacists with the skills necessary to monitor pharmacotherapy-related interventions posed in every day clinical practice through the design, implementation and evaluation of the methodologically-sound studies. The fellowship program will integrate didactic training, clinical experience and active participation in the development and completion of original research studies in the critically-ill patient populations. Development of laboratory-based analytical skills and proficiency in pharmacokinetic data analysis are additional major goals of this fellowship program. Research participation will account for more than 50% of the fellow's activities.
Over the course of the two-year program, the fellow will be expected to assume responsibility for developing 2-3 research proposals for which he or she will act as the principal researcher. Through these proposals, the fellow will gain experience at protocol development including methodological and statistical design considerations, budget preparation, the IRB submission process, grantsmanship, patient enrollment including obtainment of informed consent, chart documentation and adverse event reporting, appropriate study record keeping and data analysis. The fellow will also collaborate (in a co-researcher capacity) with the preceptor, other residents and fellows, and researchers outside the department in the design and implementation of several additional research proposals.
While independent research is the primary focus of the program, the fellow will also be exposed to multi-center Phase II, III and IV studies in terms of patient enrollment, case report documentation and IRB-related documentation. The fellow will be responsible for the preparation and submission of their research results for national presentation in the form of platform and/or poster presentation in addition to subsequent preparation and submission of a manuscript to an appropriate peer-reviewed journal for publication. He or she will have the opportunity to didactically teach pharmacy and medical resident students and other health care professionals and to precept both pharmacy residents and Pharm.D. students during their ICU rotation.
B. Length and Distribution of the Fellowship Activities
Duration of the program: 2 years
Percentage of the fellow's time spent on each activity category:
Research: 50%
Teaching: 10%
Patient Care: 40%
C. Experiences Enabling the Fellow to Become an Independent Researcher
The fellow will gain clinical research experience at Sina Hospital and laboratory research experience in Toxicology and Pharmacokinetics at TUMS. Throughout the program, he or she will be required to attend the daily rounds at Sina Hospital, the bi-weekly department of critical care research rounds, and pertinent lectures at the TUMS School of Pharmacy. The fellow will also be encouraged to attend all relevant seminars and workshops offered throughout the academic year at both TUMS and Sina Hospital, including the monthly ICU Fellowship Forum, medical grand rounds, and visiting professor presentations.
1. Clinical Research
The fellow will gain experience developing a bedside pharmacotherapy-related drug and physiological monitoring into a precise research hypothesis. Through interaction with the preceptor and collaboration with expert intensivists and physician researchers, the fellow will learn how to develop a methodologically-sound and feasible research protocol. The fellow will learn how to identify appropriate research funding sources. An emphasis will be given to participation in the application process for competitive research grants by working with the preceptor in addition to members of the Division of Critical Care Medicine at Sina Hospital, the Department of Pharmacy at TMC, and the Department of Pharmacy Practice at TUMS.
Fellows will learn how to develop a study budget that incorporates institutional or university overhead costs. They will gain experience in identifying appropriate funding agencies from discussions with the preceptor, by example (preceptor, other faculty members), and by circulation of Tehran University of Medical Sciences postings of potential grant funding agencies. The fellow will gain experience in the IRB application process (i.e. drafting consent forms and completing protocol summary forms) in addition to gaining a general appreciation for the role of the IRB and the mandatory communications (e.g. adverse event reporting, protocol extensions etc.) often necessary throughout the duration of the research protocol.
The fellow will develop skills to efficiently identify patients for both their own primary research projects in addition to those of the preceptor and attending intensive care specialists. Experience will be gained in obtaining informed consent from both patients and next-of-kin, appropriate chart documentation, as well as overcoming the barriers that can arise during the enrollment phase. Familiarity with case report form reporting procedures will also be gained, and the fellow will have the opportunity to participate in meetings with pharmaceutical study monitors, co-researchers, and research nurses. The fellow will learn to use the appropriate spreadsheet and statistical software to analyze, summarize, and interpret study results. Study results will be incorporated into an abstract and submitted for presentation to national meetings. Subsequently, the fellow will participate in the writing of a study manuscript for submission to a peer-reviewed journal.
2. Laboratory Research
The fellow will complete two months of laboratory research in either: 1) the Laboratory of Pharmacokinetic, or 2) the Toxicology Research Laboratory at TUMS.
A number of different experimental approaches are used to study these disorders in rat models. Fellows will have an opportunity to become involved in electrophysiological, anatomical, or behavioral research aimed at Sepsis, Shock, MODS, respiratory failure, Trauma etc. Extensive pharmacokinetic drug studies following acute-care illnesses could be selected.
3. Educational Opportunities
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Coursework: The fellow is required to complete coursework offered by the Graduate Program in Public Health, School of Medicine, and/or Department of Biostatistics, in the areas of Research Design, Epidemiology, and Biostatistics.
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Didactic or experiential teaching: The fellow will be actively involved in Doctor of Pharmacy courses, the research design course, and the cardiology/critical care module of the therapeutics course. Other opportunities to teach medical students, medical residents, and other allied health professionals are available. The fellow will have the opportunity to precept pharmacy residents and doctor of pharmacy students during their ICU rotation. He or she will also be expected to act as a clinical resource to other pharmacists. The fellow will also have the opportunity to complete rotations in the SICU and CCU and radiology at Sina Hospital. The fellow will not be required to provide clinical or distributive coverage.
Advance training in the areas of hemodynamic monitoring respiratory, renal, G.I etc. monitoring, and mechanical ventilation will be offered. Molecular patterns of shock, MODS sepsis and trauma, as well as advance pharmacokinetic modeling shall be discussed.
4. Other Professional Experience
The fellow will actively participate with the preceptor in academic reviewing of Critical Care Medicine, Pharmacotherapy, Annals of Pharmacotherapy, and ACCP and SCCM research abstracts. He or she will be encouraged to further develop critical appraisal and writing skills by participating in the preparation of review articles, textbook chapters, and letters to the editor. The fellow may also be required to perform minor administrative functions in the Department of Pharmacy Practice at TUMS.
D. Available Facilities
Sina Hospital is the oldest permanent medical facility in Tehran. The 500-bed medical center serves as the principal teaching hospital for TUMS and is internationally renowned for its transplantation services, general surgery by using both traditional and minimally invasive techniques, vascular surgery, cancer care, cardiology and infectious diseases. Sina Hospital is in the top ten percent of all institutions nation-wide receiving National Institute of Health Funding. Pharmacy residents have been trained in an accredited training program for more than 20 years.
Sina hospital provides care to the critically ill in a 14-bed medical intensive care unit (MICU), a 10-bed surgical ICU, a 10-bed coronary ICU. More than 300 patients are admitted each year to the hospital’s ICU. Members of the Critical Care Division of the anesthesiology Department lead a multidisciplinary approach to critical care that incorporates nursing, nutrition support, respiratory care, social work and pharmacy expertise. The ICU at Sina Hospital is a part of the project, is the site for numerous research studies, and will be the major practice, teaching and research site for the fellowship program.
Main Fellowship Topics and Course Titles
COMMON PROBLEMS
Sudden Deterioration in Neurologic Status
Agitation and Delirium
Management of Acute Pain in the Intensive Care Unit
Fever and Hypothermia
Very High Systemic Arterial Blood Pressure
Low Systemic Arterial Blood Pressure
Tachycardia and Bradycardia
Respiratory Distress with Arterial Hypoxemia
Acute Respiratory Failure
Polyuria
Oliguria
Acid-Based Disorders
Hypernatremia and Hyponatremia
Hyperkalemia and Hypokalemia
Hypophosphatemia and Hypophosphatemia
Hypomagnesaemia
Hypocalcaemia and Hypercalcaemia
Hypoglycemia
Anemia of Critical Illness
Thrombocytopenia
Coagulopathy
Hyperbilirubinemia
The Management of Gastrointestinal Bleeding
Ileus
Diarrhea
Rashes
Chest Pain
CENTRAL NERVOUS SYSTEM
Biochemical, Cellular, and Molecular Mechanisms of Neuronal Death and Secondary Brain Injury in Critical Care
Critical Neuropathophysiology
Advanced Bedside Neuromonitoring
Coma
Cardiopulmonary-Cerebral Resuscitation
Management of Acute Ischemic Stroke
Nontraumatic Intracerebral and Subarachnoid Hemorrhage
Seizures in the Critically Ill
Neuromuscular Disorders in the ICU
Traumatic Brain Injury
Spinal Cord Injury
Neuroimaging
Intensive Care after Neurosurgery
Key Issues in Pediatric Neurointensive Care
RESPIRATORY DISORDERS
Bedside Monitoring of Pulmonary Function
Principles of Gas Exchange
Arterial Blood Gas Interpretation
Respiratory System Mechanics and Respiratory Muscle Function
Heart-Lung Interactions
Assist-Control Mechanical Ventilation
Patient-Ventilator Interaction
Weaning form Mechanical Ventilation
Non-invasive Positive-Pressure Ventilation
High-Frequency Ventilation
Extracorporeal Life Support
Adjunctive Respiratory Therapy
Indications for and Management of Tracheostomy
Hyperbaric Oxygen in Critical Care
Imaging of the Chest in the ICU
Acute Lung Injury and Acute Respiratory Distress Syndrome
Aspiration Pneumonitis and Pneumonia
Severe Asthma Exacerbation
Chronic Obstructive Pulmonary Disease
Pulmonary Embolism
Other Embolic Syndromes
Pulmonary Hypertension
Pleural Disease in the Intensive Care Unit
Community-Acquired Pneumonia
Nosocomial Pneumonia
Pulmonary Infections in the Immunocompromised Patient
Lung Transplantation
Burns and Inhalation Injury
Drowning
Acute Parenchymal Disease in Infants and Children
Pulmonary Edema
CARDIOVASCULAR DISORDERS
Hemodynamic Monitoring
Acute Coronary Syndromes: Pathophysiology and Diagnosis
Acute Coronary Syndromes: Management and Complications
Invasive Cardiac Procedures: Percutaneous Transluminal Coronary Angioplasty, Mitral and Aortic Valvuloplasty
Supraventricular Arrhythmias
Ventricular Arrhythmias
Conduction Disturbances and Cardiac Pacemakers
Sudden Cardiac Death: Implantable Cardioverter-Defibrillators
Severe Heart Failure
Myocarditis in the Intensive Care Unit
Acquired and Congenital Heart Disease in Children
Pericardial Diseases
Emergent Valvular Disorders
Infectious Endocarditis
RESPIRATORY DISORDERS
Bedside Monitoring of Pulmonary Function
Principles of Gas Exchange
Arterial Blood Gas Interpretation
Respiratory System Mechanics and Respiratory Muscle Function
Heart-Lung Interactions
Assist-Control Mechanical Ventilation
Patient-Ventilator Interaction
Weaning form Mechanical Ventilation
Noninvasive Positive-Pressure Ventilation
High-Frequency Ventilation
Extracorporeal Life Support
Adjunctive Respiratory Therapy
Indications for and Management of Tracheostomy
Hyperbaric Oxygen in Critical Care
Imaging of the Chest in the ICU
Acute Lung Injury and Acute Respiratory Distress Syndrome
Aspiration Pneumonitis and Pneumonia
Severe Asthma Exacerbation
Chronic Obstructive Pulmonary Disease
Pulmonary Embolism
Other Embolic Syndromes
Pulmonary Hypertension
Pleural Disease in the Intensive Care Unit
Community-Acquired Pneumonia
Nosocomial Pneumonia
Pulmonary Infections in the Immunocompromised Patient
Lung Transplantation
Burns and Inhalation Injury
Drowning
Acute Parenchymal Disease in Infants and Children
Pulmonary Edema
CARDIOVASCULAR DISORDERS
Hemodynamic Monitoring
Acute Coronary Syndromes: Pathophysiology and Diagnosis
Acute Coronary Syndromes: Management and Complications
Invasive Cardiac Procedures: Percutaneous Transluminal Coronary Angioplasty, Mitral and Aortic Valvuloplasty
Supraventricular Arrhythmias
Ventricular Arrhythmias
Conduction Disturbances and Cardiac Pacemakers
Sudden Cardiac Death: Implantable Cardioverter-Defibrillators
Severe Heart Failure
Myocarditis in the Intensive Care Unit
Acquired and Congenital Heart Disease in Children
Pericardial Diseases
Emergent Valvular Disorders
Infectious Endocarditis
Metronidazole and Other Antibiotics for Anaerobic Infections
Prevention and Control of Nosocomial Pneumonia
Vascular Catheter-Related Infections
Pathophysiology of Sepsis and Multiple Organ Dysfunction
Sepsis and Multiple Organ System Failure in Children
Acute Bacteremia
Infections of the Urogenital Tract
Central Nervous System Infections
Infections of Skin, Muscle and Soft Tissue
Head and Neck Infections
Human Immunodeficiency Virus Infection
Infections in the Immunocompromised Patient
Infectious Endocarditis
Fungal Infections
Tuberculosis
Malaria and Other Tropical Infections in the Intensive Care Unit
Rickettsial Diseases
Acute Viral Syndromes
Clostridium Difficile Colitis
Tetanus
Botulism
Dengue Hemorrhagic Fever
PHARMACOTHERAPY of HEMATOLOGIC and ONCOLOGIC DISORDERS
Anemia and Red Blood Cell Transfusion in Critically Ill Patients
Blood Component Therapy Management of Neutropenic Cancer Patients
Venous Thromboembolism in Medical Surgical Critically Ill Patients
Hematologic Malignancies in the Intensive Care Unit
The Hematopoietic Stem Cell Transplantation Patient
Organ Toxicity of Cancer Chemotherapy
Hematology and Oncology in Children
PHARMACOTHERAPY of ENDOCRINE DISORDERS
Hyperglycemic Comas
Hyperglycemia and Blood Glucose Control in the Intensive Care Unit
Adrenal Insufficiency
Thyroid Gland Disorders
Diabetes Insipidus
Metabolic and Endocrine Crises in the Pediatric Intensive Care Unit
THE OBSTETRIC PATIENT
Cardiovascular and Endocrinologic Changes Associated with Pregnancy
Hypertensive Disorders in Pregnancy
Acute Pumonary Complications in Pregnancy
Postpartum Hemorrhage
Trauma in the Gravid Patient
PHARMACOLOGY AND TOXICOLOGY
General Principles of Pharmacokinetics and Pharmacodynamics
Poisoning: Overview of Approaches for Evaluation and Treatment
Ethanol, Methanol and Ethylene Glycol
Anticonvulsants in the Intensive Care Unit
Calcium Channel Blocker Toxicity
Drug Dosing in the Patient with Renal Failure
Antidepressant Drug Overdose
Clinical Use of Immunosuppressants
Digitalis
Heavy Metals
Hydrocarbons
Lithium
Theophylline and Other Methylxanthines
Antipsychotics
Principles of NSAID Therapy in Critical Care Medicine
Opioids
Pesticides and Herbicides
Sedatives and Hypnotics
Toxic Inhalations
Pharmacoeconomics in Critical Care
PHARMACOKINETICS
Dose Effect Relationships
ICU Drug Distribution and Pharmacologic Effects
Multiple Receptor Responses
Pharmacokinetic and Shock Modeling in – Vivo
Clearance Following Mechanical Ventilation
Drug and Tissue Binding in ICU
Sequential and Parallel Metabolic Pathways
Blood Flow, Oxygenation and Drug Clearance
Computer Simulation for Accumulation Parameters and Non-Linear Pharmacokinetics
Drug Assay Procedures
SURGERY AND TRAUMA
Resuscitation of Hypovolemic Shock
Mediasinitis
Epistaxis
Management of the Postoperative Cardiac Surgical Patient
Management of Patients with Heart and Lung Transplants
Management of Patients with Kidney Pancreas, or Kidney/Pancreas Transplantation
Liver Transplantation
Intestinal and Multiple Organ Transplantation
Aortic Dissection
Splanchnic Ischemia
Abdominal Compartment Syndrome
Thrombolytics
Atheromatous Embolization
Pressure Ulceration
Management of Pain, Anxiety and Delirium
Burns
Thoracic Trauma
Abdominal Trauma
Pelvic and Major Long Bone Fractures
Pediatric Trauma
Management of the Brain-Dead Organ Donor
Non-Heartbeating Organ Donation
ETHICAL AND END-OF-LIFE ISSUES
Technology: Caring for the Critically Ill
Resource Allocation in the Intensive Care Unit
Ethical Issues in the Intensive Care unit
Ethical Controversies in Pediatric Critical Care
End-of-Life Issues in the Intensive Care Unit
Determination of Death by Neurologic Criteria
ORGANIZATION, MANAGEMENT AND EDUCATION
Building Bedside Collaborative Practice
The Pursuit of Performance Excellence
Severity of Illness Indices and Outcome Prediction: Development and Evaluation
Evaluating Pediatric Critical Care
Key Issues in Critical Care Nursing
Transport Medicine
Disaster Medicine for the ICU Physician
Evidence-Based Critical Care
Teaching Critical Care
All interested applicants are welcome to apply to TUMS by completing and submitting TUMS online application form in which they need to specify their school, level, and major of interest.