BACKGROUNDColleges and schools of pharmacy have undergone major curricular changes to better prepare first-professional degree doctor of pharmacy students for practice and to enhance problem-solving skills. The use of techniques that foster active learning and critical thinking are necessary to accomplish this task. Despite increased efforts to enhance active learning, many pharmacy educators have difficulty engaging and maintaining the interest of all students in large classrooms. 1 Engaging students throughout a lecture is believed to make them more active participants rather then passive listeners. 2 Lecturing alone often provides only factual information to students, without enabling them to apply the knowledge. Relying on hand-raising or volunteered responses to questions posed by instructors in class usually only secures responses from a small number of more outspoken students. Other techniques have been used to determine student understanding of concepts and areas of confusion during class (eg, short quizzes, asking students to write down questions they have, etc). However, it takes time to review the students' responses. Thus, it is difficult for instructors to fully assess the degree of student comprehension of the material as it is being presented.Reports from as early as the 1970s on the use of electronic response systems in educational programs showed that such systems could serve as useful tools in large classrooms. 3 Audience response systems (ARS) are electronic tools that provide instantaneous feedback to facilitators and audience members about participants' responses (anonymously) to multiple-choice questions. ARS technology has largely been used by the corporate sector at training meetings and conferences, or as interactive trivia gaming system in taverns. Studies of ARS in corporate training have reported enhanced trainee interest, attentiveness, and retention. 4 The term interactive student response (ISR) system was coined for referring to these systems in the classroom setting. The typical ISR system includes a computer and specific software, a projector and screen, a radio signal receiver unit or a directly wired receiver unit, and personal hand-held units Objective. The purpose of this study was to evaluate the impact of an interactive student response (ISR) system on student learning, interest, and satisfaction. Methods. Students enrolled in 3 courses, Clinical Pharmacokinetics, Medical Literature Evaluation, and Pathophysiology and Therapeutics, were taught using either a traditional lecture format (study year 1) or an ISR system format (study year 2). Primary outcomes of interest were performance on examinations and student attitudes. Results. Students using the ISR system had better scores on the Clinical Pharmacokinetics examination questions (mean scores, 82.6% ± 9.6% vs 63.8% ± 8.3%, p <0.001), on the cumulative final examination for Medical Literature Evaluation (82.9% ±11.5% vs 78.0% ± 12.2%, p = 0.016), and on the evaluable "analysis type" examination questions in the Pathophysio...

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Experience with IV VPA in the treatment of SE is too limited to recommend its use as a first-line agent. IV VPA may represent a third- or fourth-line option in cases of SE when other agents are ineffective or contraindicated.

Critically ill patients with alcoholism are at greater risk of morbidity and mortality from alcohol withdrawal syndrome than are patients without alcoholism. Benzodiazepines are considered the drugs of choice for the prevention and treatment of alcohol withdrawal syndrome, but some studies have suggested that intravenous ethanol may be as effective as those agents, as well as being less sedating. We evaluated the evidence regarding the use of intravenous ethanol for the prevention and treatment of alcohol withdrawal syndrome in critically ill patients in order to determine its role in this patient population. Because of the paucity of well-designed clinical trials, and because of intravenous ethanol's questionable efficacy, inconsistent pharmacokinetic profile, and relatively narrow therapeutic index, routine use of this drug is not recommended in critically ill patients who have alcohol withdrawal syndrome or are at risk for it.

The penetration of ceftazidime, a new broad-spectrum cephalosporin, into fluids from subcutaneous threads, suction blisters, and cantharidin blisters was studied in eight healthy male volunteers. A pharmacokinetic analysis showed fundamental differences between the models. The results obtained with the subcutaneous thread technique were similar to those of the peripheral compartment and were characteristic of a rapidly equilibrating compartment. The results obtained with the suction and cantharidin blister techniques were characteristic of slowly equilibrating compartments. We concluded that although one model will not accurately predict the penetration of an antibiotic in all clinical situations, each model will have its own particular application.A variety of models are available for assessing extravascular penetration of antibiotics (6) without recourse to surgery or tissue extirpation. In volunteers the methods for collecting tissue fluid include dermabrasion with skin window (8) or skin chamber (13), blisters induced by cantharidin (12) or suction (5), and subcutaneous tissue cages (1) or cotton threads (9). The results obtained with these models are often used to predict antibiotic concentrations in tissue fluids in general. However, for a given antibiotic we have observed different tissue fluid-time proffles depending on the experimental model used, and this has also been reported by others (2, 15; B. Hoffstedt et al., Eur. J. Clin. Bacteriol., in press). These differences could be due either to minor modifications in technique (e.g., route and method of administration of antibiotics or the site from which the extravascular tissue was sampled), or to more fundamental physiopathological reasons.To investigate the problem we attempted to assess simultaneously as many of the available techniques as practicable under standardized conditions. We chose three methods which allowed multiple timed samples to be obtained and which were well tolerated by the volunteers. These methods were subcutaneous cotton threads, suction blisters, and cantharidin blisters. To minimize differences due to site, we chose to obtain all samples from the forearm. The antibiotic used in this study was ceftazidime, a broad-spectrum, antipseudomonal cephalosporin, given as a single 1-g bolus intravenous injection. MATERIALS AND METHODSVolunteers. Eight healthy male volunteers averaging 34 years in age (range, 26 to 49 years) and 72 kg in weight (range, 64 to 86 kg) took part in the study. Each volunteer gave written informed consent and underwent a routine medical examination before taking part. The study was approved by an ethical review committee.Threads. At 18 h before doses were given, each volunteer had 10 or 11 cotton threads of diameter of 0.90 mm inserted subcutaneously into the lateral aspect of the right forearm, using 1% lignocaine and an aseptic technique. The length of thread inserted subcutaneously was 2 to 3 cm. The arm was covered with sterile gauze which was left in place until each thread was removed.Cantharidin blister...