The Integrated Clinical Education Strategic Initiatives Project-Development of Parameters to Guide Harmonization in Clinical Education: A Scoping Review.

BACKGROUND: Clinical education curricular models specifically related to integrated clinical education (ICE) vary across physical therapist education programs. The interconnectedness of ICE to the advancement of a shared vision for clinical education in professional physical therapist education needs investigating. PURPOSE: The purpose of this scoping review was to: (1) define ICE, (2) define baseline expectations and parameters of ICE, and (3) discern and describe current ICE models. DATA SOURCES: Databases accessed included Medline, MedlinePlus with Full, CINAHL, and CINAHL Plus with full text. STUDY SELECTION: A multimodal data collection scoping review was completed. Data collection included survey research, a systematic review of the literature, and a series of focus groups. The McMaster Critical Appraisal Tool assessed methodological study quality. A qualitative, metasynthesis approach was used for data synthesis. Consensus agreement produced results. DATA EXTRACTION: Twenty-two articles were included in the literature review from the health disciplines of medicine, nursing, physical therapy, occupational therapy, and speech-language pathology. Data synthesis produced 8 parameters defining the factors essential to categorizing clinical education experiences as ICE in physical therapist education. The 8 parameters and ICE definition are supported by a description of models of ICE that currently exist within health profession curricula. DATA SYNTHESIS: Data synthesis followed a qualitative, metasynthesis approach. Themes emerged from the surveys, literature review, and focus group data. Patterns were compared, analyzed, and synthesized to generate the themes and ICE parameters. LIMITATIONS: Selection bias from the literature search could have limited the richness of the model descriptions by unintentional exclusion of articles, and might limit the applicability of results beyond the United States. Sampling bias from survey and focus groups, although purposeful, might have limited a broader description of current viewpoints about ICE. However, the data sources, including multiple health profession perspectives coupled with consensus agreement, provide sound evidence in development of profession-based parameters. CONCLUSIONS: The results of this scoping review provide the profession with a standard definition of ICE and parameters that can guide a program in designing a curriculum using ICE experiences as a foundation. A recommended next step is to design education research studies using reliable and valid outcome measures across programs to determine impact and effectiveness of ICE as an educational intervention.

Cockroach proteases increase IL-8 expression in human bronchial epithelial cells via activation of protease-activated receptor (PAR)-2 and extracellular-signal-regulated kinase.

BACKGROUND: We have shown that serine proteases in German cockroach extract increase TNF-alpha-induced expression of IL-8 in human bronchial epithelial cells. The mechanism by which cockroach proteases regulate cytokine expression is unknown; however, protease-activated receptors (PARs) might play a role. OBJECTIVE: We sought to determine the role of PARs and extracellular-signal-regulated kinase (ERK) in cockroach-induced regulation of IL-8 expression. METHODS: 16HBE14o- human bronchial epithelial cells were treated with the specific PAR-1 and PAR-2 agonists, TFRIFD and SLIGKV, respectively. IL-8 transcription was assessed by transiently transfecting cells with a luciferase-tagged IL-8 promoter construct, and in some cases, dominant-negative expression vectors. To block PAR cleavage, antibodies against the cleavage region of PAR-1 and PAR-2 were used. ERK phosphorylation was determined by Western blot. RESULTS: Although both PAR-1 and PAR-2 were endogenously expressed in 16HBE14o- cells, selective activation of PAR-2 but not PAR-1 mimicked the effect of cockroach extract on IL-8 expression. Using a blocking antibody against cleavage of PAR-2 but not PAR-1 attenuated cockroach-extract-induced responses, suggesting that cockroach proteases cleave PAR-2. Treatment of cells with cockroach extract and SLIGKV each increased phosphorylation of ERK. Chemical or genetic inhibition of Ras and mitogen-activated protein kinase/ERK (MEK), upstream activators of ERK, each attenuated cockroach- and PAR-2-induced IL-8 transcription. CONCLUSION: Cockroach proteases and PAR-2 activation synergistically increase TNF-alpha-induced IL-8 transcription via activation of ERK. These data suggest an important role for PAR-2 and ERK activation in the regulation of cytokine expression in airway epithelium in response to cockroach proteases.