Juvenile Dermatomyositis Magnetic Resonance Imaging Score (JIS) does not correlate with criteria for clinically inactive disease: a single-centre retrospective evaluation.

The Paediatric Rheumatology International Trials Organisation (PRINTO) criteria for clinically inactive disease (CID) and their proposal for glucocorticoid tapering do not consider MRI findings, despite the growing use of MRI and development of reliable MRI scoring tools. We aim to evaluate how CID correlates with MRI scores and physician decision making. We retrospectively used the Juvenile Dermatomyositis Imaging Score (JIS) to score MRIs of all children with JDM over a 10-year period. Demographic, diagnosis, treatment and core set measures data were collected. Correlation between CID and JIS was assessed as well as correlation with the physician treatment decision. There were 25 patients with 59 follow-up episodes to analyse correlation between physician treatment decision and JIS; and 50 episodes for the CID category and JIS correlation. JIS was not significantly associated with the CID category but did correlate with the physician decision. No significant association was found between clinical decision and CID category. The JIS area under the ROC curve (AUC) was 0.80 (95% CI 0.62-0.99) with a score ≥ 8 to predict an escalation. JIS sensitivity and specificity were both 78% with accuracy of 78%, compared to only 67%, 46% and 49%, respectively, for the CID criteria. Clinical criteria alone are not sufficient to assess disease activity status. Clinical decision trends correlated to MRI findings but not PRINTO CID criteria. Multi centre prospective studies are needed to replicate our findings and establish how to best use MRI as a biomarker of disease activity.

Stereotyping as a barrier to collaboration: Does interprofessional education make a difference?

This research was part of a Health Canada funded initiative developed to provide evidence about the effectiveness of interprofessional education (IPE) interventions to promote collaborative patient-centred care. Health professional students' ratings of health professions and the effect of IPE on those ratings were examined. Participants were divided into three groups (N=51); control, education, and practice site immersion. Utilizing the Student Stereotypes Rating Questionnaire (SSRQ) which consists of a five point Likert-type scale each group rated health professionals on nine characteristics: academic ability, interpersonal skills, professional competence, leadership, practical skills, independence, confidence, decision-making, and being a team player (Hean, Macleod-Clark, Adams, and Humphris, 2006). Data were collected at four time points; prior to an IPE classroom intervention, following an IPE classroom intervention, following the IPE immersion experience, and four months post IPE immersion experience. Overall, perceptions of other health professions were more positive following the 2.5day interprofessional education session and immersion experience. Student ratings of the seven professions among the nine characteristics will be presented, highlighting similarities and differences across professional groups. Findings support the incorporation of IPE curricula that address the role and functions of other health care professions to facilitate the development collaborative patient-centred care health care teams.

What clinical learning contracts reveal about nursing education and patient safety.

While it is widely accepted that adopting a systems perspective is important for understanding and addressing patient safety issues, nurse educators typically address these issues from the perspective of individual student performance. In this study, the authors explored unsafe patient care events recorded in 60 randomly selected clinical learning contracts initiated for students in years 2, 3, and 4 of the undergraduate nursing program at the University of Manitoba. The contracts had been drawn up for students whose nursing care did not meet clinical learning objectives and standards or whose performance was deemed unsafe. Using qualitative content analysis, the authors categorized data pertaining to 154 unsafe patient care events recorded in these contracts.Thirty-seven students precipitated these events. Most events were related to medication administration (56%) and skill application (20%). A breakdown of medication administration events showed that the highest number were errors related to time (33%) and dosage (24%). International students and male students were responsible for a higher number of events than their numbers in the sample would lead one to expect. The findings support further study related to patient safety and nursing education.

Teaching excellence in nursing education: a caring framework.

Nursing education plays a central role in the ability to practice effectively. It follows that an optimally educated nursing workforce begets optimal patient care. A framework for excellence in nursing education could guide the development of novice educators, establish the basis for evaluating teaching excellence, and provide the impetus for research in this area. However, a review of the social sciences and nursing literature as well as a search for existing models for teaching excellence revealed an apparent dearth of evidence specific to excellence in nursing education. Therefore, we developed the Caring Framework for Excellence in Nursing Education. This framework evolved from a review of the generic constructs that exemplify teaching excellence: excellence in teaching practice, teaching scholarship, and teaching leadership. Nursing is grounded in the ethic of caring. Hence, caring establishes the foundation for this uniquely nursing framework. Because a teaching philosophy is intimately intertwined with one's nursing philosophy and the ethic of caring, it is also fundamental to the caring framework. Ideally, this framework will contribute to excellence in nursing education and as a consequence excellence in nursing practice and optimal patient care.

Best medical practices in social accountability and continuing professional development: a survey and literature review.

The authors surveyed Canadian medical schools to identify gaps in current continuing professional development (CPD) with reference to social accountability and compared the results to best practices identified in a literature review. The literature review identified 15 relevant articles. Several themes on best practices emerged. In a fundamental social contract with society, physicians receive privileges in return for responding to social needs. CPD is part of this contract. To meet the terms of the contract, CPD must be credible, unbiased and respond to social needs. Physicians have a responsibility to maintain quality; CPD is one tool to do that. CPD should be measured against values of relevance, quality, cost effectiveness, and equity. The survey asked all 17 Canadian medical schools to report CPD initiatives that respond to societal needs. Eleven schools responded with descriptions of 28 such initiatives. Most initiatives focused on values of quality and relevance; fewer focused on cost effectiveness. Most often, initiatives addressed medical expertise and interprofessional collaboration, least often health advocacy. Faculty initiated most initiatives, rather than students, community or society. These findings lead to recommendations for future directions of CPD.

Interprofessional continuing health education for diabetic patients in an urban underserved community.

The CPD(iQ) Saskatchewan Project (ICEC(4)) is directed by the Inter-Professional Continuing Education for Collaborative Client Centered Care Committee, representing the disciplines of medicine, nursing, physical therapy, pharmacy, kinesiology and dentistry at the University of Saskatchewan. It was designed to serve two target audiences: the urban underserved community that would access services at the West Winds Primary Care Centre; and health professionals at the West Winds who would deliver educational modules to those in need. The main objectives were to identify the learning needs of health professionals related to working collaboratively in urban underserved community settings; identify and develop relevant educational modules to address needs identified, implement the program, and evaluate participants' experience with the educational modules. Evaluation consisted of debriefing after each educational session and the completion of a self administered questionnaire. Findings from this pilot study. The results of the study suggest the modules as a useful approach to addressing some of the barriers to effective inter-professional collaborative care. Common themes from the evaluation included satisfaction with learning other professionals' contributions to patient care. The module format may serve useful in an inter-professional case-based clinical educational setting.

Nursing students with disabilities: one faculty's journey.

Legislation requires universities to provide reasonable accommodations for students with disabilities to facilitate their access to post-secondary education. In the case of professional programs, educators must think beyond the classroom and consider the implications for clinical practice. The nature of some students' accommodations prompted concerns about the students' ability to meet program expectations. This paper describes the explorations and actions of the University of Manitoba Faculty of Nursing regarding working with undergraduate nursing students with disabilities. The paper includes a summary of literature, strategies adopted to facilitate access to nursing education for students with disabilities, and issues that require further attention.

The care needs of community-dwelling seniors suffering from advanced chronic obstructive pulmonary disease.

AIM: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD). BACKGROUND: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population. METHODS: This study was guided by the research question: "What are the care needs and care priorities of senior citizens with end-stage COPD?" An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006. FINDINGS: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others. CONCLUSIONS: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

Imaging of muscle disorders in children.

Muscle inflammation is a relatively common pathological process in childhood. The diagnosis of the underlying cause relies on an appreciation of the pattern of clinical features, as well as the results of biochemical, histological and radiological investigations. Often the clinical and biochemical features are non-specific and insensitive. Consequently, the radiological abnormalities are very important in establishing a diagnosis and an understanding of the imaging features of muscle inflammatory disorders in childhood is needed. Some of the imaging protocols needed to investigate a variety of muscle and soft-tissue inflammatory conditions in childhood are reviewed in this article. Those features that are helpful in narrowing the differential diagnosis are indicated and a logical approach to the investigation of affected children is provided. The value of MR imaging is highlighted.

Principles of management of musculoskeletal conditions in children and young people.

Musculoskeletal symptoms and rheumatic conditions are common throughout childhood and adolescence. Age- and development-appropriate care and management of children and young people with such conditions is vital, acknowledging that they are NOT small adults! The major aspect of both paediatric and adolescent rheumatology care which differentiates it from adult care is the fact that children and young people are still growing, in contrast to the ageing and senescence which characterizes adult rheumatology. Growth must be considered in the global sense, incorporating cognitive and psychosocial growth as well as physical growth. Likewise, the reciprocal influences of growth and a chronic rheumatic condition should be considered when caring for young people with childhood-onset rheumatic disease. This chapter will detail the general principles of management of such symptomatology with primary reference to chronic conditions.

Chromatin remodeling and cancer.

The fate of the cell relies on a delicate balance between gene expression and repression. The transcriptional control of the genome is maintained not only by transcription factors but also chromatin remodeling proteins. The purpose of the chromatin remodeling proteins is to alter the nucleosome architecture such that genes are exposed to or hidden from the transcriptional machinery. The nucleosome can be restructured by two mechanisms: 1. the movement of nucleosomes along DMA which is carried out by ATP-dependent chromatin remodeling complexes; and 2. the modification of core histones by histone acetyltransferases, deactylases, methyltrans-ferases, and kinases. Since these chromatin remodeling proteins play an essential role in transcriptional regulation, it is not surprising that they have been linked to cancer. In this review, we provide a general overview on chromatin remodeling and describe known genetic alterations of chromatin remodeling proteins in human cancers. We also discuss potential other, as yet unexplored strategies that cancers might take to manipulate the chromatin remodeling machinery.

Ask and ye shall plan. A health needs assessment of a university population.

BACKGROUND: In the development process of establishing a Campus Health Resource Centre, a health needs assessment of 691 students was conducted at the University of Manitoba. METHODS: Students were surveyed by their peers to identify the health education needs of this population. The process of the health needs assessment is described and the results have formed the basis for a range of programs and services offered on campus. RESULTS: Students showed interest in learning about stress management, cold and flu prevention, ergonomics and lifestyle (exercise, nutrition) issues. CONCLUSION: Of note is low interest in topics generally thought to be important to students such as contraception, safer sex, and STD/AIDS prevention.