Unveiling the impact of interprofessional education on shaping students' interprofessional identity and collaboration perception: a mixed-method study.

BACKGROUND: Interprofessional education (IPE) has the potential to shape students' collaboration perception and interprofessional identity but remains understudied. This study aims to understand the effects of the IPE program as a contextual trigger to promote collaboration perception change and interprofessional identity formation among healthcare professional students. METHODS: Using concurrent triangulation mixed-methods, we examined the relationship between collaboration perception and interprofessional identity change among health profession students (N = 263), and explored their perspectives on how their IPE experiences influenced their perception and identity. Participants completed the Interdisciplinary Education Perception Scale and Extended Professional Identity Scale and responded to open-ended questions before and after the IPE intervention. Pearson's correlation, t-tests, regression (quantitative), and thematic analysis (qualitative) were conducted. RESULTS: Teams with initially lower collaboration perception (M = 3.59) and lower interprofessional identity (M = 3.59) showed a significant increase in collaboration perception (M = 3.76, t = 2.63; p = .02) and interprofessional identity (M = 3.97, t = 4.86; p < .001) after participating in IPE. The positive relationship between collaboration perception and interprofessional identity strengthened after participating in IPE, as evident from the correlation (Time 1: r = .69; p < .001; Time 2: r = .79; p < .001). Furthermore, collaboration perception in Time 1 significantly predicted the variance in interprofessional identity at Time 2 (ß = 0.347, p < .001). Qualitative findings indicated that 85.2% of students expressed that IPE played a role in promoting their interprofessional identity and collaboration attitudes. CONCLUSIONS: Incorporating the IPE program into the curriculum can effectively enhance students' collaboration perception and interprofessional identity, ultimately preparing them for collaborative practice in the healthcare system. By engaging students in interprofessional teamwork, communication, and joint decision-making processes, the IPE program provides a valuable context for students to develop a sense of belonging and commitment to interprofessional collaboration.

Uncovering the factors underlying collaboration outcomes in interprofessional education: A preliminary investigation involving healthcare students.

BACKGROUND: Interprofessional education (IPE) incorporates healthcare students from various disciplines to learn with, about, and from one another, aiming to foster effective collaboration. However, the factors that promote these collaboration outcomes remain elusive. Recognizing this knowledge gap, this study utilizes self-determination theory applied in a ten-day IPE programme. The study aims are twofold: to clarify the potential influence of personal factors (autonomy, competence, and relatedness) and environmental factors (clear goals and technology support) on collaboration outcomes (team goal achievement and team effectiveness) and to examine the effect of the IPE on these outcomes. METHODOLOGY: The study utilized an IPE programme that integrated asynchronous and synchronous learning methods across two institutions in Hong Kong and the United Kingdom. This involved 147 students from diverse healthcare disciplines who were enrolled in the IPE programme. A pre- and post-test design was employed to examine programme effects. Multiple regression analysis was conducted to explore the factors influencing these outcomes, while paired samples t-tests were used to evaluate the effect of the IPE programme on collaboration outcomes. RESULTS: Among the personal factors, a sense of relatedness emerged as an important predictor of team effectiveness and goal achievement. Clear goals and technology support positively influenced collaboration outcomes. A paired samples t-test indicated significant improvements in collaboration outcomes after the IPE simulation. CONCLUSION: These findings highlight the importance of designing a large IPE programme that meets basic psychological needs (especially the sense of relatedness) and provides clear goals and adequate technology support in the IPE context. This study is helpful to understand how personal and environmental factors promote the collaboration outcomes in medical education and provide insights for future IPE curriculum development.

Unpacking the perceptions and experiences of student facilitators in interprofessional education: a qualitative study.

Enhancing health professional students' effective learning and collaborative practice requires a deep understanding of strategies for facilitating interprofessional learning. While faculty members and clinical preceptors are recognized as facilitators in interprofessional education (IPE), there is limited knowledge about the impact of student facilitators' engagement in IPE. Accordingly, this study aims to explore the perceptions and experiences of student facilitators in IPE. Thirteen student facilitators were recruited to lead an interprofessional learning program, and they were subsequently invited to participate in one-on-one interviews. An interview guide was developed to explore their motivations, expectations, engagement, effectiveness, and achievements in IPE facilitation. Thematic analysis was conducted using MAXQDA software to analyze the student facilitators' experiences and perceptions. Eight interviewees from various disciplines, including Medicine, Nursing, Pharmacy, Speech and Hearing Sciences, and Social Work, took part in the study. The findings revealed that student facilitators highly valued their IPE facilitation experience, which aligned with their expectations and led to the creation of social networks, increased confidence, improved understanding of other professions, and the development of lifelong skills. Furthermore, the student facilitators demonstrated cognitive and social congruence by establishing a relaxed learning environment, displaying empathetic and supportive behaviors, and using inclusive language to engage IPE learners in group discussions. This study provides a comprehensive understanding of the role of student facilitators in IPE, contributing to the evolving literature on IPE. A conceptual framework was developed to explore the entire facilitation experience, encompassing the motivations and expectations of student facilitators, their engagement and effectiveness, and the observed achievements. These findings can inform the development of peer teaching training in IPE and stimulate further research in identifying relevant facilitator competencies for optimal delivery of IPE.

inHEART Models software - novel 3D cardiac modeling solution.

INTRODUCTION: Advanced cardiac imaging is an important component in pre-procedural planning for ventricular tachycardia (VT) ablations. inHEART's proprietary software, inHEART Models, and its academic version, Multimodality Platform for Specific Imaging in Cardiology (MUSIC), provide detailed characterization of anatomical structures and scars. AREAS COVERED: This review highlights the current overview of the market and offers insight into inHEART Models and MUSIC and its application during VT ablations with supporting case examples. An overview of the clinical profile and regulatory status of inHEART Models, and other competing technologies, such as Automatic Detection of Arrhythmia Substrate (ADAS) 3D software and Catheter Precision's View into Ventricular Onset (VIVO), are also discussed. EXPERT OPINION: inHEART and MUSIC utilization has increased over the last few years and continues to establish its presence as an important aspect of VT ablations. Its unique proprietary software sets itself apart from others in the field. The introduction of dual source-photon counting detector computed tomography (PCD-CT) is expected to make significant advancements in the field and take imaging to a new level. inHEART's continued research in cardiac imaging and digital technology is expected to increase as is its global presence in the electrophysiology (EP) community.

Substrate Imaging Before Catheter Ablation of Ventricular Tachycardia: Risk Prediction for Acute Hemodynamic Decompensation.

BACKGROUND: The PAINESD (Pulmonary disease, Age, Ischemic cardiomyopathy, NYHA functional class, Ejection fraction, Storm, Diabetes mellitus) risk score has been validated as a predictor of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing ventricular tachycardia (VT) ablation. Whether the addition of total scar volume (TSV) determined by preprocedure computed tomography imaging provides additional risk stratification has not been previously investigated. OBJECTIVES: The purpose of this study was to evaluate the impact of TSV on the risk of AHD and its adjunctive benefit to the PAINESD score newly modified as Pulmonary disease, Age, Ischemic cardiomyopathy, NYHA class, Ejection fraction, Storm, Scar volume, Diabetes mellitus (PAINES2D) based on the addition of scar volumes. METHODS: This was a retrospective analysis of all index VT ablations at a quaternary care center from 2017 to 2022. Associations between TSV and AHD were evaluated among patients with structural heart disease. RESULTS: Among 61 patients with TSV data, 13 (21%) had periprocedural AHD. TSV and PAINESD were independently associated with AHD risk. Both TSV and PAINESD were associated with AHD (P = 0.016 vs P = 0.053, respectively). The highest TSV tertile (≥37.30 mL) showed significant association with AHD (P = 0.018; OR: 4.80) compared to the other tertiles. The PAINESD and PAINES2D scores had significant impact on AHD (P = 0.046 and P = 0.010, respectively). The PAINES2D score had a greater impact on AHD compared to PAINESD (area under the curve: 0.73; P = 0.011; 95% CI: 0.56-0.91 and area under the curve: 0.67; P = 0.058; 95% CI: 0.49-0.85, respectively). CONCLUSIONS: Addition of TSV to a modified PAINESD score, PAINES2D, enhances risk prediction of AHD. Further prospective study is needed to assess benefit in various cardiomyopathy populations undergoing VT ablation.

Low Perceived Social Rank Increases the Impact of Mental Health Symptoms on Suicidal Ideation: Evidence among Young Adults from the Philippines.

Studies on social factors that could influence the mental health-suicidal ideation link remain scarce, especially in non-Western contexts. This study examined the relationship between mental health symptoms (i.e., depression, anxiety, and stress) and suicidal ideation and whether one's perceived social rank moderates such a relationship. Data from 631 students from two universities in the Philippines collected between October to December 2018 was analyzed. Bivariate correlations show that greater symptoms of depression, anxiety, and stress are associated with increased suicidal ideation. Hierarchical linear regression models supported the direct relationship between mental health symptoms and suicidal ideation and demonstrated that perceived social rank significantly moderated such a relationship. Johnson-Neyman plots and simple slopes analyses further illustrate how mental health symptoms and perceived social rank interact to impact suicidal ideation. The results show that as one's perceived social rank lowers, the strength of the positive association between depression, anxiety, and stress symptoms to suicidal ideation strengthens. The results held while controlling for age, gender, college year level, and family income. The findings are discussed using the social rank theory and the Integrated Motivational-Volitional (IMV) model of suicide to view suicidal ideation from both an individual and a social perspective. We expound on the role of low perceived social rank on suicidal ideation among young adults.HIGHLIGHTSHigher depression, anxiety, and stress symptoms are associated with higher suicidal ideation.Perceived social rank moderates the link between mental health symptoms and suicidal ideation.One's perception of being inferior to others can exacerbate suicidal ideation.

Validating the Suicide Behavior Questionnaire-Revised among Filipino adults during the COVID-19 pandemic.

The study aimed to examine the validity of the Suicide Behavior Questionnaire-Revised (SBQ-R) among adult Filipinos experiencing severe depression symptoms during the COVID-19-related lockdowns in 2020. Results support SBQ-R's internal reliability. Confirmatory factor analyses supported SBQ-R's one-factor structure and its measurement invariance across gender and age. The SBQ-R's positive relationship with negative affect and its negative relationships with positive affect and family support demonstrate the questionnaire's criterion-related validity. The SBQ-R's cutoff of ≥8 shows that 78% of the sample were at-risk for suicide. The SBQ-R is valid in assessing suicide risk among severely depressed adults during the COVID-19 pandemic.

A Practical Insecticide Resistance Monitoring Bioassay for Orally Ingested Dinotefuran in Anopheles Malaria Vectors.

Attractive Toxic Sugar Baits (ATSB) deployed outdoors are likely to be particularly effective against outdoor biting mosquitoes and, if they contain insecticides with a different mode of action, mosquitoes resistant to pyrethroids. One such ATSB based on the neonicotinoid dinotefuran is currently under evaluation in Africa. As with any insecticide-based intervention, it will be important to monitor for the possible emergence of vector resistance. While methods for detecting resistance to insecticides via tarsal contact are recommended by the World Health Organization (WHO), these may not be applicable for orally ingested insecticides. Here, a new ingestion assay, appropriate for a controlled laboratory setting, is described using fluorescein sodium salt (uranine) as a feeding marker. Conventional topical application bioassays, more appropriate for routine deployment, have also been used to apply dinotefuran to the thorax of adult Anopheles mosquitoes with an organic carrier to bypass lipid cuticle barriers. The two methods were compared by establishing lethal doses (LD) in several Anopheles strains. The similarity of the ratios of susceptibility to dinotefuran between pairs of pyrethroid susceptible and resistant strains validates topical application as a suitable, more practical and field applicable method for monitoring for the emergence of resistance to orally ingested dinotefuran. A discriminating dose is proposed, which will be further validated against field populations and used to routinely monitor for the emergence of resistance alongside ATSB trials.

The factor structure and measurement invariance of the PHQ-4 and the prevalence of depression and anxiety in a Southeast Asian context amid the COVID-19 pandemic.

This study examined the psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) as an ultra-brief screener of depression and anxiety in the Philippines during the COVID-19 outbreak. Data from 4,524 non-clinical community respondents aged 18-73 years old was collected online between March and July 2020. We evaluated the screener's factor structure, measurement invariance, and criterion-related validity using confirmatory factor analysis (CFA), multigroup CFA, and structural equation modeling (SEM), respectively. We also evaluated the accuracy of the PHQ-4 cut-off scores by comparing the them with the screeners' full scales (i.e., PHQ-9 and GAD-7). Using the cutoff scores of the screeners, we also estimated the prevalence rates of depression and anxiety. The PHQ-4 has good internal reliability (Cronbach's α = 0.82). The CFA results show that the two-factor model has an excellent model fit that is superior to the one-factor model. The two-factor model held through increasingly constrained multigroup CFA models across gender, age, and geographical location groups, demonstrating measurement invariance. The SEM model supported the PHQ-4's theoretical association to stress, negative affect, and positive affect, supporting the screener's criterion-related validity. In estimating prevalence rates, among those screened by the PHQ-4 cut-off scores for depression (n = 1,905, 42.11%) and anxiety (n = 1,853, 40.96%), 81.78% and 94.06% were consequently screened by the PHQ-9 and GAD-7, respectively. This study supports the reliability, validity, and measurement invariance of the PHQ-4 as an ultra-brief screener of depression and anxiety in a large community sample in Southeast Asia. The inclusion of ultra-brief screeners in COVID-19-related studies and other human disasters, especially among non-clinical samples in low- and middle-income countries, is relevant for the sustainable evaluation and monitoring of the severity mental health symptoms leading to timely and effective mental health service provision.

Coronavirus Pandemic Anxiety Scale (CPAS-11): development and initial validation.

The mental health impact of the COVID-19 pandemic will increase as the outbreak continues and persist even after the pandemic passes. We developed an 11-item Coronavirus Pandemic Anxiety Scale (CPAS-11) to measure symptoms of anxiety related to the COVID-19 pandemic to help identify individuals who might need mental health services. In developing the scale items, we considered previous research and theory on anxiety symptoms and symptoms reported by clinically referred cases in the Philippines. The scale was validated in a Filipino sample (N = 925). Exploratory factor analysis indicated two factors corresponding to somatic and non-somatic symptoms; confirmatory factor analysis showed good fit for the two-factor model. CPAS-11 showed good internal consistency, convergent and divergent validity, and screening accuracy. A cutoff score of 15 showed adequate sensitivity and specificity to distinguish GAD-7 screened participants. The results support the viability of CPAS-11 as a screening tool to identify individuals experiencing COVID-19-related anxiety.

Intravascular ultrasound and angiographic demonstration of left main stem thrombus-high-risk presentation in a young adult with anabolic steroid abuse.

We present a case of acute myocardial infarction in a young adult with a history of anabolic steroid abuse. On diagnostic coronary angiography and intravascular ultrasound, he was found to have a distal left main stem thrombus extending into the proximal left anterior descending artery and a large intermediate vessel. As he was hemodynamically stable and pain-free, he was managed conservatively with triple antiplatelet therapy (aspirin, clopidogrel, and abciximab). This was also to avoid the risk of 'wiring the vessel,' especially if there was underlying dissection. Repeat angiography a few weeks later showed complete thrombus resolution. This is the first reported case of extensive left main stem thrombus in a young patient with anabolic steroid abuse. Management of such cases is not straightforward and our case highlights one approach to both diagnosis and treatment.

The cost of implementing UK guidelines for the management of chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases. METHODS: We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed. RESULTS: In the first year, a practice of 10,000 would identify 147.5 patients with stages 3-5 CKD over and above those already known. All stages 4-5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline>or=5 ml/min/1.73 m2/year, 1.11 with haemoglobin<11 g/dl and 1.67 with blood pressure>150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was euro 6111; and euro 7836 for nephrology referral. Total costs of euro 17 133 in the first year were increased to euro 29,790 through the effect of creatinine calibration. CONCLUSIONS: CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10,000 patients managed according to guidelines.

Global expression analysis of cancer/testis genes in uterine cancers reveals a high incidence of BORIS expression.

PURPOSE: Cancer/testis (CT) genes predominantly expressed in the testis (germ cells) and generally not in other normal tissues are aberrantly expressed in human cancers. This highly restricted expression provides a unique opportunity to use these CT genes for diagnostics, immunotherapeutic, or other targeted therapies. The purpose of this study was to identify those CT genes with the greatest incidence of expression in uterine cancers. EXPERIMENTAL DESIGN: We queried the expression of known and putative CT gene transcripts (representing 79 gene loci) using whole genome gene expression arrays. Specifically, the global gene expressions of uterine cancers (n = 122) and normal uteri (n = 10) were determined using expression data from the Affymetrix HG-U133A and HG-U133B chips. Additionally, we also examined the brother of the regulator of imprinted sites (BORIS) transcript by reverse transcription-PCR and quantitative PCR because its transcript was not represented on the array. RESULTS: Global microarray analysis detected many CT genes expressed in various uterine cancers; however, no individual CT gene was expressed in more than 25% of all cancers. The expression of the two most commonly expressed CT genes on the arrays, MAGEA9 (24 of 122 cancers and 0 of 10 normal tissues) and Down syndrome critical region 8 (DSCR8)/MMA1 (16 if 122 cancers and 0 of 10 normal tissues), was confirmed by reverse transcription-PCR methods, validating the array screening approach. In contrast to the relatively low incidence of expression of the other CT genes, BORIS expression was detected in 73 of 95 (77%) endometrial cancers and 24 of 31 (77%) uterine mixed mesodermal tumors. CONCLUSIONS: These data provide the first extensive survey of multiple CT genes in uterine cancers. Importantly, we detected a high frequency of BORIS expression in uterine cancers, suggesting its potential as an immunologic or diagnostic target for these cancers. Given the high incidence of BORIS expression and its possible regulatory role, an examination of BORIS function in the etiology of these cancers is warranted.