Interprofessional education between dentistry and pharmacy students: delivery, barriers and facilitating implementation.

Interprofessional education (IPE) between dentistry and pharmacy students is an approach to teach effective collaborative practice between a team of future health care providers. It relies on the support and motivation of students, staff and professionals to implement a variety of educational strategies and might involve evaluating student progression before and after delivery. Many barriers exist towards the implementation of IPE between dentistry and pharmacy health disciplines and outlining experiences across educational/clinical practice settings and possible solutions would assist in reducing those walls to realization. Implementation of IPE between pharmacy and dentistry undergraduate programs might lead to improved workplace collaborations and reduce medication errors, adverse events and increase in cross-referrals. Interprofessional education within undergraduate training forms the first steps towards reducing the burden on health care systems by enabling effective collaboration to improve patient outcomes. This narrative review describes IPE strategies used between pharmacy and dentistry undergraduate disciplines to enable collaboration, discusses the barriers and facilitators towards implementing IPE, and future directions for IPE education between these two disciplines.

The mechanical stress-strain properties of single electrospun collagen type I nanofibers.

Knowledge of the mechanical properties of electrospun fibers is important for their successful application in tissue engineering, material composites, filtration and drug delivery. In particular, electrospun collagen has great potential for biomedical applications due to its biocompatibility and promotion of cell growth and adhesion. Using a combined atomic force microscopy (AFM)/optical microscopy technique, the single fiber mechanical properties of dry, electrospun collagen type I were determined. The fibers were electrospun from a 80 mg ml(-1) collagen solution in 1,1,1,3,3,3-hexafluro-2-propanol and collected on a striated surface suitable for lateral force manipulation by AFM. The small strain modulus, calculated from three-point bending analysis, was 2.82 GPa. The modulus showed significant softening as the strain increased. The average extensibility of the fibers was 33% of their initial length, and the average maximum stress (rupture stress) was 25 MPa. The fibers displayed significant energy loss and permanent deformations above 2% strain.

Strength and failure of fibrin fiber branchpoints.

See also Weisel JW. Biomechanics in hemostasis and thrombosis. This issue, pp 1027-9; Liu W, Carlisle CR, Sparks EA, Guthold M. The mechanical properties of single fibrin fibers. This issue, pp 1030-6.

The mechanical properties of single fibrin fibers.

SUMMARY BACKGROUND: Blood clots perform the mechanical task of stemming the flow of blood. OBJECTIVES: To advance understanding and realistic modeling of blood clot behavior we determined the mechanical properties of the major structural component of blood clots, fibrin fibers. METHODS: We used a combined atomic force microscopy (AFM)/fluorescence microscopy technique to determine key mechanical properties of single crosslinked and uncrosslinked fibrin fibers. RESULTS AND CONCLUSIONS: Overall, full crosslinking renders fibers less extensible, stiffer, and less elastic than their uncrosslinked counterparts. All fibers showed stress relaxation behavior (time-dependent weakening) with a fast and a slow relaxation time, 2 and 52 s. In detail, crosslinked and uncrosslinked fibrin fibers can be stretched to 2.5 and 3.3 times their original length before rupturing. Crosslinking increased the stiffness of fibers by a factor of 2, as the total elastic modulus, E(0), increased from 3.9 to 8.0 MPa and the relaxed, elastic modulus, E(infinity), increased from 1.9 to 4.0 MPa upon crosslinking. Moreover, fibers stiffened with increasing strain (strain hardening), as E(0) increased by a factor of 1.9 (crosslinked) and 3.0 (uncrosslinked) at strains epsilon > 110%. At low strains, the portion of dissipated energy per stretch cycle was small (< 10%) for uncrosslinked fibers, but significant (approximately 40%) for crosslinked fibers. At strains > 100%, all fiber types dissipated about 70% of the input energy. We propose a molecular model to explain our data. Our single fiber data can now also be used to construct a realistic, mechanical model of a fibrin network.

Opportunistic screening for genital chlamydial infection. I: acceptability of urine testing in primary and secondary healthcare settings.

OBJECTIVES: To determine the acceptability of opportunistic screening for Chlamydia trachomatis in young people in a range of healthcare settings. DESIGN: An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples tested by ligase chain reaction (LCR). Data on uptake and testing were collected and in-depth interviews were used for programme evaluation. SETTING: General practice, family planning, genitourinary medicine clinics, adolescent sexual health clinics, termination of pregnancy clinics, and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics) in two health authorities (Wirral and Portsmouth and South East Hampshire). Main participants: Sexually active women aged between 16 and 24 years attending healthcare settings for any reason. MAIN OUTCOME MEASURES: Uptake data: proportion of women accepting a test by area, healthcare setting, and age; overall population coverage achieved in 1 year. Evaluation data: participants' attitudes and views towards opportunistic screening and urine testing. RESULTS: Acceptance of testing by women (16-24 years) was 76% in Portsmouth and 84% in Wirral. Acceptance was lower in younger women (Portsmouth only) and varied by healthcare setting within each site. 50% of the target female population were screened in Portsmouth and 39% in Wirral. Both the opportunistic offer of screening and the method of screening were universally acceptable. Major factors influencing a decision to accept screening were the non-invasive nature of testing and treatment, desire to protect future fertility, and the experimental nature of the screening programme. CONCLUSIONS: An opportunistic model of urine screening for chlamydial infection is a practical, universally acceptable method of screening.

Opportunistic screening for genital chlamydial infection. II: prevalence among healthcare attenders, outcome, and evaluation of positive cases.

OBJECTIVES: To determine the prevalence and treatment outcomes among young women screened opportunistically for genital Chlamydia trachomatis and to evaluate the impact of screening in those participating. DESIGN: An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples, tested by ligase chain reaction (LCR). In-depth interviews were used for programme evaluation. SETTING: Screening was offered in two health authorities at general practice, family planning, genitourinary medicine (GUM), adolescent sexual health, termination of pregnancy clinics and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics). Main participants: Sexually active women (16-24 years) attending for any reason. MAIN OUTCOME MEASURES: Screening data: prevalence of infection by age and healthcare setting; proportion of positive patients attending for treatment. Evaluation data: participants' attitudes and views towards screening and follow up. RESULTS: In total, 16 930 women (16-24 years) were screened. Prevalence was higher in younger women (16-20) than those aged 21-24 years and was highly variable at different healthcare settings (range 3.4%-17.6%). Prevalence was approximately 9% in general practice. The role of the project health advisers in managing results and coordinating treatment of positive individuals was essential; the vast majority of all positives were known to be treated. Women felt that screening was beneficial. Improving awareness and education about sexually transmitted infections is required to alleviate negative reactions associated with testing positive for infection. CONCLUSIONS: Prevalence of infection outside GUM clinics is substantial and opportunistic screening using urine samples is an acceptable method of reaching individuals with infection who do not normally present at specialist clinics.

Developing an evidence base for interdisciplinary learning: a systematic review.

AIM OF THE STUDY: The overall aim of the study was to explore the feasibility of introducing interdisciplinary education within undergraduate health professional programmes. This paper reports on the first stage of the study in which a systematic review was conducted to summarize the evidence for interdisciplinary education of undergraduate health professional students. METHODS: Systematic reviews integrate valid information providing a basis for rational decision making about health care which should be based on empirical and not anecdotal evidence. The accepted principles for systematic reviews were adapted in order to allow integration of the literature to produce recommendations for educational practice and guidelines for future research. FINDINGS: The literature on interdisciplinary education was found to be diverse, including relatively small amounts of research data and much larger amounts of evaluation literature. Methodological rating schemes were used to test for confounding influences in the research studies. The number of studies found was 141 but only 30 (21%) were included in the analysis because of lack of methodological rigour in the research and poorly developed outcome measures. CONCLUSIONS: Student health professionals were found to benefit from interdisciplinary education with outcome effects primarily relating to changes in knowledge, skills, attitudes and beliefs. Effects upon professional practice were not discernible and educational and psychological theories were rarely used to guide the development of the educational interventions.

Microwave process for volatile organic compound abatement.

The CHA Corporation has completed the U.S. Air Force Phase II Small Business Innovation Research program to investigate the feasibility of using a novel microwave-based process for the removal and destruction of volatile organic compounds (VOCs) in effluents from noncombustion sources, such as paint booth ventilation streams. Removal of solvents by adsorption, followed by the regeneration of saturated granular activated carbon (GAC) by microwave energy, was achieved in a single fixed-bed reactor. Microwave regeneration of the fixed-bed-saturated carbon restored the original GAC adsorption capacity. After 20 adsorption/regeneration cycles, the adsorption capacity dropped from 13.5 g methyl ethyl ketone (MEK)/100 g GAC to 12.5 g MEK/100 g GAC. During microwave regeneration of the GAC fixed bed, the concentrated desorbed paint solvent was oxidized by passing the solvent mixture through a fixed bed of an oxidation catalyst mixed with silicon carbide in a microwave reactor. A 98% oxidation efficiency was consistently achieved from the oxidation of VOCs in the microwave catalytic reactor.

Simple predictors of uvulopalatopharyngoplasty outcome in the treatment of obstructive sleep apnea.

STUDY OBJECTIVE: Our objective was to determine whether baseline polysomnography, cephalometry, and anthropometry data could predict uvulopalatopharyngoplasty (UPPP) success or failure. DESIGN: We retrospectively reviewed polysomnography, cephalometry, and anthropometry data from patients who underwent UPPP for obstructive sleep apnea (OSA). SETTING: A university medical center. PATIENTS: OSA was diagnosed by polysomnography in 46 patients who underwent UPPP surgery for their sleep disorder. INTERVENTIONS: UPPP surgery with/or without tonsillectomy. MEASUREMENTS AND RESULTS: The mean patient age was 43 years, and the mean body mass index was 32.5 kg/m(2). The mean presurgical apnea-hypopnea index (AHI) was 45, and the mean baseline nadir oxygen saturation was 81%. Successful surgery was defined as a reduction in AHI to < 10 or to < 20 with a 50% reduction from the patient's baseline AHI. Of the 46 patients, 16 were successfully treated and 30 did not respond to surgical treatment. A mandibular-hyoid distance (MP-H) > 20 mm was found to be significantly (p = 0.05) predictive of failure of UPPP. When stepwise regression analysis was performed utilizing postsurgical AHI as the dependent variable and presurgical AHI, age, body mass index, baseline nadir O(2) saturation, and five cephalometric measurements as independent variables, MP-H distance significantly (r = 0.524; p = 0.01) correlated positively with postsurgical AHI. The distance between the superior point of a line-constructed plane of the sphenoidale (parallel to Frankfort horizontal) and a point at the intersection of the palatal plane perpendicular to the hyoid correlated negatively with postsurgical AHI (r = 0.586; p = 0.05). By creating a logistic model of this data, an MP-H distance < 21 mm, an angle created by point A to the nasion to point B < 3 degrees, and the presence of a baseline AHI < 38 enhanced the predictability of UPPP success. CONCLUSIONS: The presence of a baseline AHI < 38 and an MP-H < or = 20 mm, and the absence of retrognathia are predictors of improvement after UPPP. Based on these findings, we would advocate the continued evaluation of cephalometric measurements and careful consideration of surgical treatment options for OSA.

Did Project 2000 nurse training change recruitment patterns or career expectations?

In the UK, Project 2000 nurse education, introduced over the last eight years, aimed to increase the professional status of nurses and enhance skills, focusing on wider community care. This paper reports some of the results from a research project conducted between 1994 and 1996, funded by the Department of Health (Project 2000 Fitness for Purpose 1996). It was hypothesized that the changes in Project 2000 training might attract those more academically qualified and lead to more rapid career progression. The results found in this study did not support either of these hypotheses and suggestions are made about the reasons for the negative findings.

Choices and control: parental experiences in pediatric terminal home care.

During the past decade, palliative care at home has become an alternative option to hospital care for terminally ill children. This study describes the experience of caring for a dying child at home from a parent's perspective. A qualitative research design was used to conduct and analyze data. Nonstandardized, focused interviews were conducted with 10 families. Thematic content analysis assisted in deriving themes from the transcripts of the interviews. "Choice and control" was the major theme that linked all the other concepts, and it appeared to be fundamental to parental coping strategies. Most parents were willing to take responsibility for the nursing care of their child, including administration of intravenous medication. The patient's home was the overwhelming choice of parents for delivery of terminal care, with most parents perceiving it as their child's choice also.

The search for meaning in HIV and AIDS: the carers' experience.

This article explores informal carers' experiences in caregiving for people living with HIV and AIDS. The search for meaning encompasses the ways in which carers find meaning in caregiving. A grounded theory approach was taken. Data were collected by means of 43 in-depth interviews and participant observation. Caregivers felt that it was important to have control over the emphasis that HIV had within their lives and developed an attitude that put the virus in perspective. Getting involved in HIV and AIDS work outside of the immediate caregiving relationship was evident. The motivation for this was in part a reaction to prevailing societal views on HIV and in part altruistic in that it provided further meaning for the caregiving experience. This study suggests that finding meaning in caregiving is a powerful way to achieve a balance between the costs of caregiving and personal reward.

Sex reversal caused by Mus musculus domesticus Y chromosomes linked to variant expression of the testis-determining gene Sry.

When the Y chromosomes from certain populations of Mus musculus domesticus are introduced into the mouse strain C57BL/6 (B6), testis determination can fail, resulting in gonads developing either as ovotestes (with both ovarian and testicular components) or as ovaries. Not all Y(DOM) chromosomes cause sex reversal. Y(DOM) chromosomes are divided into three classes based upon their ability to induce testes in B6. The molecular basis underlying the three Y(DOM) classes is an enigma. The simplest explanation is that they harbor different alleles of the testis-determining gene, Sry. Sequencing of Sry(DOM) genes has indeed identified polymorphisms. However, none were unequivocally linked to the sex-reversal trait. It was concluded that all SRY(DOM) proteins are functionally equivalent. Using a semiquantitative RT-PCR assay, we now show that representatives of the three Y(DOM) classes have variant Sry expression patterns, that severity of sex reversal correlates with Sry mRNA titers, and that genetic correction of the sex reversal results in the upregulation of Sry expression. We propose that the variant Sry expression patterns result from polymorphisms at the site of a putative Sry enhancer.

Skills competency in nurse education: nurse managers' perceptions of diploma level preparation.

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the 'fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the 'core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.

The role of the primary care physician in recognizing obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is a common disorder among middle-aged adults. However, OSA is a recently described disorder for which most primary care physicians do not have formal training. The primary objectives of this article are to evaluate what percentage of patients referred by primary care physicians for sleep studies had OSA; to characterize the clinical features of these patients and compare them with our known OSA population; and to determine whether primary care physicians asked key questions contained in a work sheet to make the diagnosis of OSA. METHODS: A retrospective chart review at a hospital-based sleep center that is accredited to evaluate all sleep disorders, not just OSA. The health maintenance organization is a staff model one. PATIENTS: Sixty-nine patients who were referred for a sleep study by a health maintenance organization internist or family practitioner between June 1, 1994, and May 30, 1995. RESULTS: Ninety-six percent of the 68 patients referred for polysomnography had OSA. Most were very symptomatic and obese. These 68 patients represent 0.13% of the primary care patient panel. In addition, most of the patients were referred by a few physicians; 6 (11%) of the 55 physicians ordered 33% of the 68 studies. CONCLUSIONS: Primary care physicians did recognize obese patients with prominent symptoms of sleep apnea. However, only a small percentage of their patient panel was referred, suggesting that this condition is still underdiagnosed. This seems particularly true as most of the sleep studies were ordered by a small group of physicians. Future work incorporating educational interventions is necessary to improve detection and treatment of OSA.

Doppler measurement of hepatic arterial flow in dogs: technique and preliminary findings.

The common hepatic artery in 10 healthy adult beagles, 20 healthy pups (13 Deerhounds and seven Irish Wolfhounds), and seven dogs with either a congenital or acquired hepatic disorder was examined by duplex-Doppler ultrasonography. Peak systolic velocity (Vs), resistive index (RI), pulse rate, angle of insonation, and sample volume depth were recorded. Measurements in Beagles were made after a 24 h fast and repeated 2 h after feeding. The mean Vs and RI in fasted Beagles were 1.5 m/s (range 1.1-2.3 m/s) and 0.68 (range 0.62-0.74), respectively. Postprandially, there were no significant differences in any of these variables. Mean Vs and RI were lower in pups: 1.0 m/s (range 0.8-1.3 m/s) and 0.59 (range 0.46-0.65), respectively (P < .001). Two dogs with congenital arterioportal fistula had higher mean Vs (P < .001) and lower mean RI (P < .05) than normal pups. No significant differences were detected between normal Beagles, three dogs with portal vein thrombosis, and two dogs with acquired hepatic insufficiency. Differences in measured hepatic blood flow in dogs of different age or breed will complicate diagnostic use of hepatic arterial Doppler measurements.

The convergent validity of the Matson Evaluation of Social Skills for individuals with Severe Retardation (MESSIER).

The convergent validity of the Matson Evaluation of Social Skills for Persons with Severe Retardation (MESSIER) was examined. We administered the MESSIER and the Vineland Adaptive Behavior Scales (VABS) to 892 individuals with severe and profound mental retardation residing in a residential state facility. The MESSIER subscales were compared to equivalent subdomains from the VABS that have been demonstrated through research to be both reliable and valid. Significant positive correlations were found between corresponding MESSIER subscales and VABS subdomains on social behaviors. The findings also indicated that this pattern of positive correlation remained constant when comparing both verbal and nonverbal social behaviors. The implications and clinical utility of the findings are discussed.

Identification and modification of environmental noise in an ICU setting.

STUDY OBJECTIVES: Noise levels in the hospital setting are exceedingly high, especially in the ICU environment. We set out to determine what caused the noises producing sound peaks > or = 80 A-weighted decibels (dBA) in our ICU settings, and attempted to reduce the number of sound peaks > or = 80 dBA through a behavior modification program. DESIGN: The study was divided into two separate phases: noise identification and a trial of behavior modification. During the noise identification phase we simultaneously recorded sound peaks and the loudest noise heard subjectively by one observer in the medical ICU (MICU) and the respiratory ICU (RICU). During the behavior modification phase of the study we implemented a behavior modification program, geared toward noise reduction, in all of the MICU staff. Sound levels were monitored before and at the end of the behavior modification trial. SETTING: The MICU and RICU of a 720-bed teaching hospital in Providence, RI. PARTICIPANTS: All ICU staff during the study period. INTERVENTIONS: Once the noises that were determined to be amenable to behavior modification were identified, a behavior modification program was conducted during a 3-week period in our MICU. Baseline and post-behavior modification noise recordings were compared in 6-h intervals after sites were matched by number of patients in a room and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. MEASUREMENTS AND RESULTS: We identified several causes of sound peaks > or = 80 dBA amenable to behavior modification; television and talking accounted for 49%. We also significantly reduced the 24-h mean peak noise level (p=0.0001), as well as the mean peak noise level (p=0.0001) and the number of sound peaks > or = 80 dBA (p=0.0001) in all 6-h blocks except for the 12 AM to 6 AM period. CONCLUSIONS: We conclude that many of the noises causing sound peaks > or =80 dBA are amenable to behavior modification and that it is possible to reduce the noise levels in an ICU setting significantly through a program of behavior modification.

Ovotestes in B6-XXSxr sex-reversed mice.

The sex-reversed mutation Sxr results in XX males. In the absence of any other mutations, testis differentiation in XXSxr fetuses is essentially normal and only one report of an XXSxr fetus with ovotestes is in the literature. We report that 84% (21/25) of 13 days postcoitum XXSxr fetuses on the B6 inbred genomic background have ovotestes. Ovotestes were found in fetuses from both Sxra and Sxrb variants. Examination of fetuses older than 13 dpc suggests that the presence of ovotestes is transient in most fetuses. However, one overt hermaphrodite was identified after birth. The development of ovotestes is associated with the inbred background and is exacerbated by the dominant spotting oncogene allele KitW-42J. We propose that spreading of X-inactivation into the Sxr region resulting in loss of Sry expression is more extensive in B6-Sxr strains.