Interprofessional Collaborative Care Skills and Behaviors: Perception Differences Between Allied Health Students and an Independent Observer.

Interprofessional practice and education (IPE) is incorporated into pre-licensure healthcare programs to prepare students for collaboration in clinical practice and to improve patient outcomes. The use of interprofessional simulation as a teaching strategy is increasing, but most literature involves medical and nursing students, and outcomes measure students' knowledge, perceptions, or attitudes. The purpose of this study was to compare allied health students' self-assessment of their team's interprofessional collaborative care (IPCC) skills and behaviors with an independent observer's perception during an interprofessional simulation discharge planning event with standardized patients. Students (n = 177) were recruited from the Departments of Occupational Therapy (OT), Physical Therapy (PT), and Physician Assistant Studies (PA). Students reflected on their team's performance, and an independent observer assessed each team's IPCC skills and behaviors with a valid and reliable tool developed from the IPEC Core Competencies. The results showed that students' assessments of their teams' IPCC were significantly greater than the independent observer's ratings. Additionally, the observer found that the students demonstrated higher levels of interprofessional collaboration during a team huddle without a standardized patient present. This study suggests that IPE program evaluation should include observations of interprofessional skills and behaviors and that students involved in interprofessional simulation may benefit from a team huddle prior to team interactions with a standardized patient.

Lived experiences of parents of children with disabilities engaged in a support group incorporating equines.

BACKGROUND: Parenting a child with disabilities comes with significant challenges to parental quality of life, often resulting in decreased physical, mental, and social health when compared to parents who raise typically developing children. AIMS: To address the needs of this population a 10-week interdisciplinary support group, based in attachment theory and incorporating equines, was developed called Taking the Reins of Self-care. METHODS AND PROCEDURES: Designed to utilize the human-equine bond, the support group facilitated development of self-care strategies to increase quality of life of 6 parents of children with disabilities in the United States OUTCOMES AND RESULTS: Qualitative phenomenological analysis of field notes and parent interviews revealed the following themes: confirming the horse as an emotional confidant, creating a safe haven, re-affirming identity, nourishing the emotional self, and meeting the challenge. CONCLUSIONS AND IMPLICATIONS: Analysis of Taking the Reins of Self-care substantiates the value of complimentary therapeutic approaches, attachment theory and the human-equine bond, and supports further investigation of the benefits of specialized parental support groups to enrich the experience of raising a child with disabilities.

The Anatomy Glove Learning System for Hand Anatomy and Function: Use of Embodied Learning in Occupational Therapy Education.

Occupational therapy students must build a solid foundation in hand anatomy to prepare for practice that includes interventions for people with hand injuries or impairments. To engage students in effective active learning, the Anatomy Glove Learning System (AGLS) was used in two entry-level occupational therapy programs. This cloth glove with imprinted bones was worn while students followed an online video series to draw the muscles and tendons on the hand and understand hand physiology. Research exploring student gains in hand anatomy knowledge and confidence at the two universities (n=199) over a 2-year period found statistically significant improvements in 12 of 15 items and in total scores of an anatomy quiz taken as a pre-test and post-test (t(198)=13.77, p<0.001, Cohen's d = 1.142). In addition, statistically significant differences in student confidence related to hand anatomy (t(110)=24.47, p<0.01) and student reports of positive experiences were identified after using the AGLS. This active learning system utilized a form of embodied learning to facilitate preparedness for entry-level practice of occupational therapy students to address the needs of clients with hand impairments. Future research focused on the student experience may determine additional insights into the full benefits of the AGLS and similar active learning strategies regarding hand anatomy and physiology.

The feasibility of Gazefinder under 12 months of age infants.

Eye-tracking to evaluate gaze patterns has developed as an assessment tool for children with autism spectrum disorder (ASD). Gazefinder is one of Eye-tracking devices and few studies have investigated whether it can measure the gaze data of infants under 12 months of age. We conducted a prospective cross-sectional study from April 2019 to March 2020 in a periodic health checkup in Ohchi County, Shimane, Japan. Participants included infants between 4 and 11 months of age who were not suspected the presence of developmental problems. Ninety-three participants' datapoints were analyzed. The mean age was 6.5 months and mean developmental quotient was 88%. The mean fixation time percentage of all sequences was 81.0% (standard deviation; 4.4), and there was no significant difference in each age group. Infants in all groups showed a significantly higher predilection for eyes than for mouths. There was a positive association of age with human gaze and a negative association with geometric gaze. Moreover, we confirmed that joint attention skills were enhanced in accordance with their growth process. The eye-tracking data were almost corresponding to previous studies' data of infant with typical development and Gazefinder could be applied to infants starting at 4 months of age.

Implementation of Universal Design for Learning in Occupational Therapy Education.

This exploratory research surveyed educators' use of universal design for learning (UDL) in occupational therapy education. Most common methods of engagement were displaying enthusiasm, providing examples, and offering learner feedback; representation was primarily offered through class discussion, lab experiences, and images; methods of action or expression were most frequently class discussion, projects, practicums and tests. The type of program, years of educators' clinical experience and faculty rank influenced some factors of UDL implementation. Further use of UDL principles that could facilitate improved learning outcomes of diverse learners within occupational therapy education is discussed.

Home Parenteral Nutrition Reimbursement and American Society for Parenteral and Enteral Nutrition Public Policy Efforts.

Home parenteral nutrition (HPN) has been considered a lifesaving intervention since the late 1960s for patients with gastrointestinal (GI) failure and other conditions that affect the GI tract who are well enough to be at home. Payment for this therapy under federal programs requires significant documentation and complex processes to qualify. Medicare parenteral nutrition policy, qualification processes and challenges, and advocacy supported by the American Society for Parenteral and Enteral Nutrition are reviewed with the goal of increasing clinician awareness of the complexity surrounding Medicare HPN reimbursement.

A case of an infant with congenital combined pituitary hormone deficiency and normalized liver histology of infantile cholestasis after hormone replacement therapy.

Congenital combined pituitary hormone deficiency (CPHD) may present with cholestasis in the neonate or during early infancy. However, its precise mechanism is unknown. A 3-mo-old boy presented with cryptorchidism and hypoplastic scrotum after birth. Neonatal jaundice was noted but temporarily improved with phototherapy. Jaundice recurred at 2 mo of age. Elevated direct bilirubin (D-Bil) and liver dysfunction were found but cholangiography showed no signs of biliary atresia (BA). Liver biopsy findings showed giant cell formation of hepatocytes with hypoplastic bile ducts. Subsequent magnetic resonance imaging (MRI) of the head revealed a hypoplastic pituitary gland with an ectopic posterior lobe, and the patient was diagnosed with congenital CPHD based on decreased secretion of cortisol and GH by the pituitary anterior lobe load test. D-Bil levels promptly improved after hydrocortisone (HDC) replacement. We subsequently began replacement with levothyroxine (L-T4) and GH, and liver histology showed normal interlobular bile ducts at 8 mo old. This is the first case report of proven histological improvement after hormone replacement therapy. This suggested that pituitary-mediated hormones, especially cortisol, might be involved in the development of the bile ducts.

An antibody to the beta-secretase cleavage site on amyloid-beta-protein precursor inhibits amyloid-beta production.

Proteolytic cleavage of amyloid-beta-protein precursor (AbetaPP) by beta- and gamma-secretases results in production of the amyloid-beta peptide (Abeta) that accumulates in the brains of sufferers of Alzheimer's disease (AD). We have developed a monoclonal antibody, 2B12, which binds in the vicinity of the beta-secretase cleavage site on AbetaPP but does not bind within the Abeta region. We hypothesised that this antibody, directed against the substrate rather than the enzyme, could inhibit cleavage of AbetaPP by beta-secretase via steric hindrance and thus reduce downstream production of Abeta. The antibody would enter cells by binding to AbetaPP when it is at the cell surface and then be internalised with the protein. We subsequently demonstrated that, after addition of 2B12 to standard growth media, this antibody was indeed capable of inhibiting Abeta40 production in neuroblastoma and astrocytoma cells expressing native AbetaPP, as measured by an ELISA. This inhibition was both concentration- and time-dependent and was specific to 2B12. We were only able to inhibit approximately 50% of Abeta40 production suggesting that not all AbetaPP is trafficked to the cell surface. We propose that this antibody could be used as a novel, putative therapy for the treatment of AD.

The impact of nursing practice on the history and effectiveness of total parenteral nutrition.

Nutrition support nursing grew out of the development of total parenteral nutrition in the late 1960s. Nurses contributed to the development of safe and effective delivery of parenteral nutrition and continue to serve on nutrition and metabolic teams in a variety of ways. Research demonstrating the positive effect of the nurse and the team are presented here, along with the history, evolution, and current state of nutrition support nursing.

Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia.

BACKGROUND: Artificial feeding by a percutaneous endoscopic gastrostomy (PEG) tube in patients with dementia has increased since the introduction of the endoscopic method of tube placement. Few studies have documented survival benefit from this intervention. This report reviews our experience with PEG tube placement for feeding patients with dementia. METHODS: All consultations for PEG tube placement were evaluated by a certified nutrition support nurse (L.M.M.) in consultation with a member of the gastroenterology physician staff (T.O.L.) for 24 months. Evaluation included the attainment of a brief medical history, a physical examination, and a review of comorbid conditions, laboratory variables for nutrition status, and bleeding risk. Interviews with patients or surrogates were conducted, including an explanation of the risks and benefits of PEG tube placement. A Kaplan-Meier survival curve was used to compare the median survival between patients with dementia who received a PEG tube and patients with dementia in whom PEG tube placement was refused. RESULTS: We received 41 consultations for PEG tube placement in patients with dementia. Percutaneous endoscopic gastrostomy was performed in 23 patients; 18 patients met the medical criteria for PEG tube placement, but surrogates refused placement. The median survival for the 23 patients who underwent PEG was 59 days; the median survival for the 18 patients who did not undergo PEG was 60 days. CONCLUSION: There seems to be no survival benefit in patients with dementia who receive artificial feeding by a PEG tube.