"It's like rotations, but in the classroom": Creation of an innovative course to prepare students for advanced pharmacy practice experiences.

BACKGROUND AND PURPOSE: The purpose of this article is to discuss the course development and results of a survey assessing students' perceived confidence in performing various skills after completion of this course. EDUCATIONAL ACTIVITY AND SETTING: The course was taught using a model in which all activities performed by students took place in a fictitious health system. The course was created to give students the opportunity to learn in an environment that closely mimicked advanced pharmacy practice experiences (APPEs) while in the didactic setting. Higher order active learning activities and case-based exams were utilized in the course. Students' perceived level of confidence in performing skills practiced in the course was assessed via survey after completion of each semester of the course and after the first introductory pharmacy practice experience (IPPE). Course coordinators hypothesized that this course design would improve students' perceived level of confidence in performing skills utilized in the clinical practice setting. FINDINGS: Survey data from two class cohorts were analyzed. Students' perceived level of confidence in performing skills necessary in clinical practice increased as a result of the course. DISCUSSION: This course provided students an opportunity to experience an APPE environment while still in the didactic setting. The course design meets the Center for the Advancement of Pharmacy Education (CAPE) outcomes and aids in making students "APPE-ready" prior to the start of the P4 year. SUMMARY: This unique and innovative course format allowed students to integrate knowledge learned in previous courses and apply it in a manner like what is expected in the clinical setting.

Incidence and outcomes of critical illness-related corticosteroid insufficiency in trauma patients.

The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline cortisol levels (mean 56 ± 84 vs. 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs. 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.

Enhanced expression of cyclooxygenase-2 in glaucomatous dog eyes.

OBJECTIVE: Cyclooxygenase-2 (COX-2)-derived prostaglandins (PGs) are shown to play important pathophysiologic roles in various disease states. Recently, the effectiveness of topical PGs in reducing intraocular pressure (IOP) has stimulated further interest in the physiologic function of COX-2 and PGs in normal and glaucomatous eyes. Therefore, we investigated the cell-type distribution and expression of COX-2 in normal and glaucomatous dog eyes. PROCEDURES: Using isoform-specific antibodies, we immunohistochemically evaluated COX-2 expression in formalin-fixed and paraffin-embedded normal (n = 5) and glaucomatous (n = 17) dog eyes. RESULTS: In the normal eyes, only minimal COX-2 immunoreactivity was observed in the ciliary epithelium. In the glaucomatous eyes, COX-2 expression was further observed in the cornea and corneoscleral limbus. In the cornea, moderate to strong COX-2 expression was observed in all corneal layers (epithelium, stromal cells and endothelium), with the greatest expression present in the epithelial layer. In the corneoscleral limbus area, COX-2 immunoreactivity was noted in the stromal cells of sclera, trabecular meshwork and endothelial cells of the angular aqueous plexus. CONCLUSIONS: Increased expression of COX-2 in dog glaucomatous eyes suggests that COX-2-derived PGs may have a potential role in the pathogenesis of canine glaucoma.