PIES method of critique

Innovative Approaches to Teaching Dyslipidemia Management in a Required Pharmacy Therapeutics Sequence

Objective. To describe a novel design on teaching dyslipidemia management that would help students compare and apply past and current clinical recommendations using a variety of new mechanisms. Methods. Didactic time consisted of three sections: lecture; faculty-led panel discussion; and interactive, progressive, student-driven patient case. The accompanying case studies course involved varying interactive student activities, including literature review, adverse event reporting, and immediate feedback assessment tools. Results. Students performed well on audience response questions, dyslipidemia examination questions, and in-class case studies activities. Subjective student and faculty feedback were positive for the entire innovation. Conclusion. The redesigned dyslipidemia module gives students exposure to overall management of this disease state through several innovative approaches that can be repeated in other courses to enhance learning.

Journal Club Standardization Tool: Helping participants get the JIST

BACKGROUND AND PURPOSE

Clinical pharmacy practice relies on the ability to critically evaluate clinical trials and apply their findings to patient care. The development of these skills begins in pharmacy school, develops during residency programs, and continues to mature while practicing clinical pharmacy. The purpose of this analysis was to evaluate student attitudes and perceptions following implementation of the Journal Interpretation Summary Tool (JIST) into a pharmacy curriculum.

EDUCATIONAL ACTIVITY AND SETTING

The "journal club" is an activity implemented in many curricula with the intent to hone these skills. The JIST is a standardized template aimed at improving the consistency of a journal review by organizing major elements of a trial, allowing the facilitator and participants to navigate through key information and guide the journal club discussion.

FINDINGS

Implementation of JIST resulted in an increased level of confidence for a majority of students (63.3%) when conducting and critically evaluating a journal article. More than 80% of students reported they were better able to critically evaluate a published article using JIST, and 91.9% reported JIST provided structure to the journal club process.

DISCUSSION AND SUMMARY

JIST provides the appropriate level of guidance and structure, particularly for the novice pharmacy student or pharmacist. The use of a standardized tool for journal club evaluation may lead to further improvements in applying literature to practice and other skills surrounding the critique of medical literature.

Sedation and analgesia in the intensive care unit: evaluating the role of dexmedetomidine

PURPOSE

A review highlighting the application of sedatives and analgesics in the intensive care unit (ICU) setting, with a focus on the use of dexmedetomidine, is presented.

SUMMARY

Relevant and applicable clinical trials that resulted from a search of the literature from 1966 to July 2006 using key search terms such as dexmedetomidine, intensive care unit, sedation, delirium, and analgesia were evaluated. Many agents have been evaluated in the search of the optimal regimen for sedation and analgesia in the ICU, including opioids, benzodiazepines, propofol, and antipsychotic agents. Dexmedetomidine has demonstrated efficacy as a sedative analgesic on the basis of its ability to lower opioid, benzodiazepine, and propofol requirements in clinical trials. The role of dexmedetomidine in ICU clinical practice is limited because of a lack of mortality and other morbidity endpoints, such as ICU length of stay, hospital length of stay, time to extubation, long-term complications after discharge from the ICU, and delirium. The most commonly reported adverse effects of dexmedetomidine are secondary to its effects as an alpha(2)-receptor agonist and are cardiac in nature. A detailed cost analysis may be warranted to justify the relatively high acquisition cost of dexmedetomidine.

CONCLUSION

Dexmedetomidine may be an effective agent for ICU sedation and analgesia. However, the lack of clinically relevant endpoints in trials, the concern about adverse cardiovascular effects, and the relatively high acquisition cost of this drug limit its use to a select number of patients who may benefit from its distinguished mechanism of action.