[Teaching Interprofessional Patient Pathways in Medical Education in Switzerland - A Collaboration of Multiple Players]. / Lehrveranstaltung zu interprofessionellen Versorgungsketten in der Schweiz.

Teaching Interprofessional Patient Pathways in Medical Education in Switzerland - A Collaboration of Multiple Players Abstract. The increase of chronic and complex medical disorders challenges actors in the health care system and affects the entire health care system in Switzerland. Through an interprofessional exchange between medical and health care professionals, the individual needs of patients can be better addressed, which has a positive impact on patients' treatments. To prepare students of the Bachelor of Medicine at ETH Zurich for these challenges, the ETH has designed a specific course together with four educational institutions, which is oriented towards the interprofessional, patient-centred supply chain. The aim of this interprofessional module is, that Bachelor of Medicine students, as well as Pharmacy and Nursing students, acquire knowledge about the other areas of responsibility and competences, and at the same time get to know the interfaces of interprofessional cooperations.

Naloxone modulates visual judgments of similarity but not dissimilarity.

Endogenous opioids have been implicated in mediating (placebo) analgesia, in reward processes, and in the regulation of socially relevant emotions. To explore their potential contributions to higher cognitive functions, we used a novel task with tachistoscopically presented (for 150 ms) pairs of meaningless figures. Healthy right-handed men judged the similarities and dissimilarities between the two figures on a visual analogue scale (VAS) in two separate runs. In a double-blind, between-subjects design, subjects were administered intravenously either 0.2-mg/kg naloxone or placebo 10 min prior to the task, and VAS judgments and response latencies were measured. We found a significant interaction between substance group and type of judgment: The magnitude of the similarity judgments was lower in the naloxone than in the placebo group, while dissimilarity judgments remained uninfluenced by the treatment. Reaction latencies and mood scores, assessed before and after substance administration, did not differ between the two groups, indicating that the findings did not rely on altered motor performance or motivation. We suggest that naloxone decreased the "similarity criterion" in comparative judgments, indicating its potentially modulatory effect on visual cognition. The task introduced here could be used for the implicit study and quantification of subtle affective-cognitive processes beyond the level of mere questionnaire data.

Six years after deregulation of emergency contraception in Switzerland: has free access induced changes in the profile of clients attending an emergency pharmacy in Zürich?

OBJECTIVES: Emergency contraception (EC) has been freely accessible in Swiss pharmacies since November 2002. Today some groups are still concerned that free access might result in less use of efficient contraceptive methods, overuse and more risky sexual behaviour. METHODS: Profiles of EC users one and six years after deregulation were analysed with regard to age, contraceptive methods used, reasons for EC use, and last contact with a gynaecologist. Data were collected from a centrally located pharmacy. Written official assessment forms concerning 1500 women (750 in 2004 and 750 in 2009) were analysed. RESULTS: Free access to EC use had no impact on regular contraceptive behaviour. The percentage of pill and condom users was very high (85%). The percentage of EC-users without any contraception (17-18%) was the same over the years. In 2009, condom rupture was reported more frequently (p < 0.001). In addition significantly more women had used EC previously in their history. CONCLUSION: Free access to EC has not resulted in less use of efficient contraceptive methods. In the context of falling abortion rates our results are reassuring. This also applies to adolescents, who mainly used EC as a back-up method and seldom in the context of unprotected intercourse.

Pleasure-related analgesia activates opioid-insensitive circuits.

Recent findings suggest that pain and pleasure share common neurochemical circuits, and studies in animals and humans show that opioid-mediated descending pathways can inhibit or facilitate pain. We explored the role of endogenous opioid neurotransmission in pleasure-related analgesia. µ-Opioidergic activity was blocked with 0.2 mg/kg naloxone to assess its effects on hedonic responses to pleasant emotional pictures (International Affective Picture System) and its modulating effects on heat pain tolerance. Naloxone did not alter subjective and autonomous reactions to pleasure induction or overall mood of participants. In addition, pleasure-related increases in pain tolerance persisted after reversal of endogenous µ-opioidergic neurotransmission. Subjective pain intensity and unpleasantness ratings increased after naloxone administration. These findings suggest that, in addition to opioid-sensitive circuits, mainly opioid-insensitive pain-modulating circuits are activated during pleasure-related analgesia.

Heat pain threshold and tolerance show no left-right perceptual differences at complementary sites of the human forearm.

Pain threshold and pain tolerance of heat noxious stimuli were assessed to determine whether they are equivalent when measured at three equidistant sites of both volar forearms. Heat pain threshold and tolerance were measured in 18 healthy volunteers using a standard stimulation device consisting of a thermode. Pain threshold and pain tolerance did not differ within and across forearm sites. Experimenters addressing heat pain threshold and tolerance in healthy volunteers may freely choose and change stimulation sites on both volar forearms, without the risk of confounding site effects on dependent variables. This data completes previous reports on side effects by analyzing the effect of site on the forearm for both heat pain threshold and tolerance. The absence of side and site effects may contribute to setting a more secure basis for assessments of laterality effects of painful stimulation.

Changes in self-perceived role identity modulate pain perception.

Pain is an experience including physiological and psychological factors. We assume that emotions may be elicited and increased through self-perceived role identity and that change of role identity alters quality and intensity of pain perception. We used role-play strategies to assess whether pain can be better tolerated whenever, in an unavoidable and unpleasant context, role identity confers pain a meaningful and thus suitable character. We induced antithetic roles in 21 actors who received heat stimuli on their arms before and after role-play conditions. Pain tolerance, skin conductance and voice signals were measured. Pain tolerance increased for heroes/heroines and decreased for faint-hearts. Men showed higher pain tolerance. Heroes/heroines evaluated heat stimuli as more intense. Faint-hearts found pain stimuli more affectively loaded at lower temperatures. Women showed higher pain ratings. Hence, self-perception influences pain perception. Role-play strategies may be of value for new pain management strategies.

High-level expression and purification of human thymidine kinase 1: quaternary structure, stability, and kinetics.

Human cytosolic thymidine kinase (hTK1) is the key enzyme of the pyrimidine salvage pathway and phosphorylates thymidine to thymidine monophosphate, a precursor building block of the DNA. Wild-type hTK1 (hTK1W) as well as a truncated form of the enzyme (hTK1M) carrying deletions at the N- and C-terminal regions were cloned as His(6)-tagged fusion proteins. Expression, isolation, and purification protocols have been established, leading to high yields of soluble and active wild type (approximately 35 mg) and truncated hTK1 (approximately 23 mg) per liter of culture. The protein was purified to near homogeneity. The chaperone DnaK was identified to be the major contaminant that could be removed by applying an additional ATP-MgCl(2) incubation and washing step. hTK1W was a permanent tetramer in solution, whereas the truncated construct hTK1M appears to be a dimer in absence and presence of substrates. Both hTK1W and hTK1M exhibit pronounced thermal stability with transition temperatures (T(m)) of 71.7 and 73.4 degrees C, respectively, when measured without adding substrates. The presence of substrates stabilized both hTK1W (DeltaT(m) ranging from 5.6 to 12.5 degrees C) and hTK1M (DeltaT(m) ranging from 0.8 to 5.3 degrees C). Both enzymes show high activity over a broad range of pH, temperature, and ionic strength. Kinetic studies determined a K(M) of 0.51 microM and a k(cat) of 0.28 s(-1) for wild-type hTK1. The truncated hTK1M has a K(M) of 0.87 microM and k(cat) of 1.65 s(-1), thus exhibiting increased catalytic efficiency. The availability of recombinant human TK1 will facilitate further biochemical and crystallographic studies.