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1.
Int J Pharm ; 608: 121127, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34560210

RESUMO

In vitro diffusion testing of topical formulations has long been examined using Franz diffusion chambers, however, Franz chambers are typically used with relatively large volumes, lack the air/membrane interface present in vivo, and do not account for changes in formula characteristics as solvent evaporates. Here we present our patented Munt-Dash diffusion chamber designed for direct spray application onto a model membrane. Diffusion characteristics from topical spray formulations utilizing both the Munt-Dash chamber and Franz diffusion chambers were evaluated and compared. Using diclofenac sodium and lidocaine hydrochloride as model drugs and shed snakeskin as a model for stratum corneum, test solutions were applied to Franz diffusion chambers using a pipette and to the Munt-Dash chamber using a high-speed syringe pump and sprayer. Both chambers presented permeability data consistent with previously reported in vitro and in vivo studies. Significant differences were observed in permeability by formulation and temperature. This suggests that although Franz chambers produce relevant data, the failure to account for small volumes and drying during application may produce misleading results. The Munt-Dash chamber may improve in vitro testing by providing these factors. This data suggests the Munt-Dash chamber is a suitable alternative to the Franz chamber for topical spray formulations.


Assuntos
Epiderme , Pele , Difusão , Cultura em Câmaras de Difusão , Técnicas In Vitro , Permeabilidade
2.
Occup Ther Health Care ; 34(4): 307-319, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32907452

RESUMO

The high number of patient falls occurring within acute care hospitals throughout the United States has led to increased patient impairment and contributed to rising healthcare costs. The Morse Fall Risk Scale is a commonly used assessment tool for prediction of a patient's potential for experiencing a fall while in a healthcare facility. This retrospective study reviewed the use of the Morse Fall Risk Scale in a 300+ bed acute care hospital setting to determine adequacy for patient fall predictions over a four-month period. Use of multivariate regressions and Chi-Square test statistics revealed the Morse Fall Risk Scale was a predictor of patients' fall risk in this setting with other significant predictors of fall risk potential including male gender and diagnosis (neurologic, cardiac, general medical/surgical conditions). Patients experiencing a fall had a statistically significant longer hospital stay. Occupational therapy practitioners play an important role on the interdisciplinary team by providing a comprehensive fall assessment, developing fall prevention programs, and providing discharge recommendations.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional , Valor Preditivo dos Testes , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
3.
Am J Clin Oncol ; 43(9): 640-647, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889834

RESUMO

BACKGROUND: The incidence of liver cancer has more than tripled since 1980. Hepatectomy represents the major curative treatment for liver cancer. The risk factors associated with 90-day mortality after hepatectomy are not well understood and there are currently no good prediction models for this outcome. The objectives of the current study were to identify risk factors of 90-day mortality after hepatectomy in patients with hepatocellular carcinoma and to develop an integer-based risk score using the National Cancer Database. METHODS: Hepatectomies recorded in the National Cancer Database during 2004-2012 were reviewed for 90-day mortality. Risk factors were identified by multivariate logistic regression models. An integer-based risk score was developed using the ß coefficients derived from the logistic regression model and tested for discriminatory ability. According to the total risk score, patients were grouped into 4 risk groups. RESULTS: The overall 90-day mortality was 10.2%. Ten risk factors were identified, which included sex, age, race/ethnicity, insurance status, education, annual hospital volume, stage, tumor grade, Charlson-Deyo Score, and surgical procedure. The risk of 90-day mortality was stratified into 4 groups. The calculated 90-day mortality rates were 2.47%, 5.88%, 12.58%, and 24.67% for low-risk, medium-risk, high-risk, and excessive-risk groups, respectively. An area under the receiver operating characteristic curve of 0.69 was obtained for model discrimination. CONCLUSIONS: The integer-based risk score we developed could easily quantify each patient's risk level and predict 90-day mortality after hepatectomy. The stratified risk score could be a useful addition to perioperative risk management and a tool to improve 90-day mortality after hepatectomy.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Adolescente , Adulto , Idoso , Área Sob a Curva , Carcinoma Hepatocelular/patologia , Estudos Transversais , Bases de Dados Factuais , Feminino , Previsões/métodos , Hepatectomia/estatística & dados numéricos , Humanos , Neoplasias Hepáticas/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Allied Health ; 49(2): 99-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469369

RESUMO

Collaboration to increase capacity for healthcare professionals requires careful planning, open communication, implementation, formative and summative evaluation, and sustainability. International collaboration to meet the rehabilitation needs of China requires a supportive structure of faculty and staff implementing the program. The purpose of this article is to explore the development of a collaborative international rehabilitation education program and illustrate outcomes as they relate to professional development, cultural competency, and healthcare team skills. A retrospective analysis of program assessment data was completed including pre and posttest survey results and focused interviews. Results indicate that program participants had a significant positive change in values and beliefs towards cultural diversity and increased awareness of interdisciplinary team skills which contributed to overall professional development as future rehabilitation practitioners. The description and assessment of the program also serves as a framework for the development of future collaborative international rehabilitation education programs. Future research could explore institutional growth and faculty development of collaborating educational institutions.


Assuntos
Competência Clínica/normas , Pessoal Profissional Estrangeiro/educação , Reabilitação/educação , China , Competência Cultural , Humanos , Cooperação Internacional , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
5.
J Allied Health ; 48(4): 248-256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800654

RESUMO

PURPOSE: There is insufficient evidence to support the use of interprofessional high-fidelity simulation (HFS) with occupational therapy (OT) and physical therapy (PT) students. This pilot HFS aimed to provide students an opportunity to engage in interprofessional collaborative practice (IPCP) in the acute care environment. Researchers investigated student perceptions, beliefs, and behaviors relative to IPCP. METHODS: The HFS involved a patient following total hip replacement. Pre- and post-data were collected from surveys comprised of the Interprofessional Socialization and Valuing Scale (ISVS)-9A and 9B, Simulation Design Scale (SDS), and open-ended questions. Descriptive, inferential, and thematic analyses were conducted. RESULTS: Twenty-one second-year graduate OT and PT students were recruited through convenience sampling to participate in this study. Statistically significant differences were seen with ISVS scores for all students. Students responded favorably to all SDS questions. Qualitative data yielded three major themes: 1) interprofessional communication and collaboration, 2) scope of practice, and 3) skill acquisition. CONCLUSION: HFS is a positively perceived, experiential learning strategy capable of building essential interprofessional skills and enhancing OT and PT students' attitudes and beliefs toward IPCP.


Assuntos
Treinamento com Simulação de Alta Fidelidade , Relações Interprofissionais , Terapia Ocupacional/educação , Especialidade de Fisioterapia/educação , Artroplastia de Quadril/reabilitação , Cuidados Críticos/métodos , Feminino , Treinamento com Simulação de Alta Fidelidade/métodos , Humanos , Comunicação Interdisciplinar , Masculino , Equipe de Assistência ao Paciente , Adulto Jovem
6.
J Nurs Educ ; 58(10): 577-582, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573646

RESUMO

BACKGROUND: Increasing rates of medical errors necessitate incorporation of patient safety education for health professions students. Institutions must address the needs of both campus- and distance-based learners to meet interprofessional education (IPE) accreditation requirements. The purpose of this project was to evaluate a synchronous interprofessional patient safety simulation to train students on interprofessional teamwork and communication through recognition of patient safety and medical hazards. METHOD: Students from health care professions participated in a Haunted Hospital/Heartbreak Hospital patient hazard/medical error simulation. A total of 201 students in 41 teams, both campus and distance, participated over three semesters. RESULTS: Mean Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) scores significantly improved from 44.81 ± 3.59 to 47.08 ± 3.31 (p < .0001). Qualitative responses indicated that students appreciated working with other health care students through collaborative practice and recognized the importance of discipline-specific expertise. CONCLUSION: This simulation provided campus and distance learners with a collaboration opportunity that improved their perceptions of IPE. [J Nurs Educ. 2019;58(10):577-582.].


Assuntos
Educação à Distância/organização & administração , Relações Interprofissionais , Segurança do Paciente , Treinamento por Simulação/organização & administração , Estudantes de Ciências da Saúde/psicologia , Educação de Pós-Graduação em Enfermagem/organização & administração , Feminino , Humanos , Masculino , Erros Médicos/prevenção & controle , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Qualitativa , Estudantes de Ciências da Saúde/estatística & dados numéricos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos
7.
J Allied Health ; 48(2): 119-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167014

RESUMO

BACKGROUND: The significance of evidence-based practice (EBP) cannot be overstated. However, literature on the perception of occupational and physical therapists toward EBP is scarce. METHODS: This survey study was intended to examine occupational and physical therapists' perceptions of EBP. A total of 47 of 261 practicing therapists in a health care system in the Midwest U.S. responded to the questionnaire previously developed by Rubin et al. RESULTS: The results of the study showed that therapists reported familiarity with the EBP process and maintained an overall positive attitude toward EBP. Of the five subscale measures of EBP, familiarity with EBP process had the greatest average score (3.82±0.48) followed by attitude about EBP process (3.73±0.37). The smallest mean subscale score was found on the measure of current engagement in EBP process (2.93±0.55). Therapists reported intent to engage in the EBP process but were less favorable to engage in EBP and only reported engagement in EBP a little less than "some of the time." Barriers to engaging in EBP included time, access, and the constraints of the responders' practice setting. Implications of this study resulted in recommendations for clinical practice and educational programs.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências/organização & administração , Terapeutas Ocupacionais/psicologia , Fisioterapeutas/psicologia , Adulto , Prática Clínica Baseada em Evidências/normas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Percepção
8.
Am J Pharm Educ ; 80(5): 76, 2016 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-27402979

RESUMO

Objective. To analyze student perceptions of self-efficacy in meeting medicinal chemistry course related educational outcomes and skills following a medicinal chemistry skills laboratory. Methods. Four activities were implemented in a pharmacy skills laboratory (PSL) for second-year pharmacy students. Students (n=121) worked individually on exercises for three of the four activities. Pre/post-laboratory surveys on self-efficacy were administered. The McNemar test was performed to evaluate students' self-efficacy above 70% related to course outcomes before and after the exercises in each activity. An independent t test was conducted to compare the mean of students' responses on meeting course outcomes based on the 70% anchor for the perspective confidence on meeting course outcomes. Results. The post-PSL scores on all self-efficacy questions improved. The majority of students reported skill development in all exercises. Students and clinical faculty qualitative responses indicated they felt exercises were effective. Conclusion. A PSL can serve as a valuable opportunity to address course related educational outcomes and specific skill development and can help students assess their self-efficacy in meeting them.


Assuntos
Química Farmacêutica/educação , Química Farmacêutica/normas , Avaliação Educacional/normas , Percepção , Autoeficácia , Estudantes de Farmácia/psicologia , Competência Clínica/normas , Educação em Farmácia/métodos , Educação em Farmácia/normas , Avaliação Educacional/métodos , Humanos , Distribuição Aleatória , Inquéritos e Questionários
10.
Am J Pharm Educ ; 78(7): 132, 2014 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-25258437

RESUMO

OBJECTIVE: To determine the effect of instructor attitude, enthusiasm, and teaching style on learning for distance and campus pharmacy students. METHODS: Over a 3-year period, distance and campus students enrolled in the spring semester of a medicinal chemistry course were asked to complete a survey instrument with questions related to instructor attitude, enthusiasm, and teaching style, as well as items to measure student intrinsic motivation and vitality. RESULTS: More positive responses were observed among distance students and older students. Gender did not impact student perspectives on 25 of the 26 survey questions. Student-related items were significantly correlated with instructor-related items. Also, student-related items and second-year cumulative grade point average were predictive of students' final course grades. Instructor enthusiasm demonstrated the highest correlation with student intrinsic motivation and vitality. CONCLUSION: While this study addresses the importance of content mastery and instructional methodologies, it focuses on issues related to instructor attitude, instructor enthusiasm, and teaching style, which all play a critical role in the learning process. Thus, instructors have a responsibility to evaluate, reevaluate, and analyze the above factors to address any related issues that impact the learning process, including their influence on professional students' intrinsic motivation and vitality, and ability to meet educational outcomes.


Assuntos
Atitude , Química Farmacêutica/educação , Educação à Distância/tendências , Docentes , Motivação , Estudantes de Farmácia , Adulto , Estudos de Coortes , Coleta de Dados/métodos , Educação à Distância/métodos , Educação em Farmácia/métodos , Educação em Farmácia/tendências , Avaliação Educacional/métodos , Docentes/normas , Feminino , Humanos , Masculino , Adulto Jovem
11.
Am J Pharm Educ ; 77(6): 130, 2013 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-23966733

RESUMO

OBJECTIVE: To evaluate the impact of repeated simulations and testing on the pharmacy practice skills development of third-year doctor of pharmacy (PharmD) students. DESIGN: A pharmacy practice skills laboratory was redesigned to reinforce skills development and enhance retention. Timed, repeated learning experiences that increased in complexity throughout the semester were used to test student knowledge, skills, and abilities. ASSESSMENT: Over a 5-year period, scores from skills-based activities deemed essential to professional practice and repeated 4 or more times in the course were analyzed. There was a significant improvement in scores on drug utilization reviews and patient counseling simulations despite the increasing difficulty and complexity of the medication problems presented (p <0.001). Students' scores on prescription verification and sterile product verification also improved significantly over 3 assessments (p <0.001), but then plateaued, with less improvement seen in performance on subsequent assessments. CONCLUSION: Providing multiple opportunities for students to conduct or simulate pharmacy practice activities and then test their knowledge and skills improves students' learning and performance.


Assuntos
Currículo , Educação em Farmácia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Farmácia , Estudantes de Farmácia , Avaliação Educacional , Humanos , Aprendizagem , Avaliação de Programas e Projetos de Saúde
12.
J Cancer Educ ; 24(4): 254-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19838880

RESUMO

BACKGROUND: Pediatricians need to competently care for children with hereditary gastrointestinal cancer-predisposing syndromes. Pediatrics resident education on this subject has hithertofore never been studied. METHODS: Forty-five US pediatrics/internal medicine-pediatrics program directors allowed their residents to participate in an anonymous questionnaire. The survey-questionnaire was administered as a hyperlinked interactive Web page through e-mail to all consenting residents. RESULTS: Thirty-eight sites including 290 of 1327 residents (21.5%) and 33 internal medicine-pediatrics participated in the study. Knowledge on polyposis syndromes varied by syndrome (14% to 84% correct) but not by year of training. Internal medicine-pediatrics residents were more likely to inquire on family history including polyposis, early colorectal cancer, than pediatrics residents. CONCLUSIONS: This study suggests that familiarity with cancer syndromes does not accrue during resident training in pediatrics. The observations suggest that greater emphasis on resident education on these syndromes may improve outcomes in this vulnerable group.


Assuntos
Competência Clínica , Neoplasias Gastrointestinais/genética , Predisposição Genética para Doença , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência , Pediatria/educação , Criança , Pesquisas sobre Serviços de Saúde , Humanos , Internet , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Síndrome
13.
Genesis ; 40(1): 52-7, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15354294

RESUMO

To study biologically relevant functions of the Janus kinase 2 (Jak2) in multiple cytokine and hormone receptor signal transduction pathways, we generated a conditional knockout (floxed) allele of this gene by placing loxP sites around the first coding exon of Jak2. Homozygous floxed animals developed normally and exhibited no phenotypic abnormalities. The conversion of the floxed allele into a null mutation was achieved by transmitting the targeted allele through the female germline of MMTV-Cre (line A) mice. Embryos that carry two Jak2 null alleles died around midgestation and exhibited impaired definitive erythropoiesis, which is a hallmark of Jak2 deficiency reported previously in conventional knockouts. This observation suggested that the Cre-mediated deletion of the first coding exon results in a true null mutation that is incapable of mediating signals through the erythropoietin receptor. Using mouse embryonic fibroblasts derived from Jak2 null embryos and their wildtype littermate controls, we demonstrated that Jak2-deficiency decouples growth hormone-receptor signaling from its downstream mediators, the signal transducer and activator of transcription (Stat) 5a and 5b.


Assuntos
Proteínas Tirosina Quinases/deficiência , Proteínas Tirosina Quinases/genética , Proteínas Proto-Oncogênicas/deficiência , Proteínas Proto-Oncogênicas/genética , Animais , Eritropoese/genética , Éxons/genética , Feminino , Morte Fetal/genética , Deleção de Genes , Janus Quinase 2 , Vírus do Tumor Mamário do Camundongo/genética , Camundongos , Camundongos Knockout , Gravidez
14.
Mol Cell Biol ; 24(12): 5510-20, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15169911

RESUMO

Jak2 is a hormone-receptor-coupled kinase that mediates the tyrosine phosphorylation and activation of signal transducers and activators of transcription (Stat). The biological relevance of Jak2-Stat signaling in hormone-responsive adult tissues is difficult to investigate since Jak2 deficiency leads to embryonic lethality. We generated Jak2 conditional knockout mice to study essential functions of Jak2 during mammary gland development. The mouse mammary tumor virus-Cre-mediated excision of the first coding exon resulted in a Jak2 null mutation that uncouples signaling from the prolactin receptor (PRL-R) to its downstream mediator Stat5 in the presence of normal and supraphysiological levels of PRL. Jak2-deficient females were unable to lactate as a result of impaired alveologenesis. Unlike Stat5a knockouts, multiple gestation cycles could not reverse the Jak2-deficient phenotype, suggesting that neither other components of the PRL-R signaling cascade nor other growth factors and their signal transducers were able to compensate for the loss of Jak2 function to activate Stat5 in vivo. A comparative analysis of Jak2-deficient mammary glands with transplants from Stat5a/b knockouts revealed that Jak2 deficiency also impairs the pregnancy-induced branching morphogenesis. Jak2 conditional mutants therefore resemble PRL-R knockouts more closely, which suggested that Jak2 deficiency might affect additional PRL-R downstream mediators other than Stat5a and Stat5b. To address whether Jak2 is required for the maintenance of PRL-responsive, differentiating alveolar cells, we utilized a transgenic strain that expresses Cre recombinase under regulatory elements of the whey acidic protein gene (Wap). The Wap-Cre-mediated excision of Jak2 resulted in a negative selection of differentiated alveolar cells, suggesting that Jak2 is required not only for the proliferation and differentiation of alveolar cells but also for their maintenance during lactation.


Assuntos
Glândulas Mamárias Animais/crescimento & desenvolvimento , Proteínas do Leite , Proteínas Tirosina Quinases/deficiência , Proteínas Proto-Oncogênicas , Animais , Diferenciação Celular , Divisão Celular , Proteínas de Ligação a DNA/deficiência , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Células Epiteliais/citologia , Células Epiteliais/enzimologia , Células Epiteliais/transplante , Feminino , Janus Quinase 2 , Lactação/genética , Lactação/metabolismo , Glândulas Mamárias Animais/citologia , Glândulas Mamárias Animais/enzimologia , Camundongos , Camundongos Knockout , Fenótipo , Gravidez , Prolactina/metabolismo , Proteínas Tirosina Quinases/genética , Proteínas Tirosina Quinases/fisiologia , Receptores da Prolactina/metabolismo , Fator de Transcrição STAT5 , Transdução de Sinais , Transativadores/deficiência , Transativadores/genética , Transativadores/metabolismo
15.
Mol Cell Biol ; 23(1): 150-62, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12482969

RESUMO

Tumor susceptibility gene 101 (Tsg101) was identified in a random mutagenesis screen for potential tumor suppressors in NIH 3T3 cells. Altered transcripts of this gene have been detected in sporadic breast cancers and many other human malignancies. However, the involvement of this gene in neoplastic transformation and tumorigenesis is still elusive. Using gene targeting, we generated genetically engineered mice with a floxed allele of Tsg101. We investigated essential functions of this gene in vivo and examined whether the loss of function of Tsg101 results in tumorigenesis. Conventional knockout mice were generated through Cre-mediated excision of the first coding exon in the germ line of mouse mammary tumor virus (MMTV)-Cre transgenic mice. The complete ablation of Tsg101 in the developing embryo resulted in death around implantation. In contrast, mammary gland-specific knockout mice developed normally but were unable to nurse their young as a result of impaired mammogenesis during late pregnancy. Neither heterozygous null mutants nor somatic knockout mice developed mammary tumors after a latency of 2 years. The Cre-mediated deletion of Tsg101 in primary cells demonstrated that this gene is essential for the growth, proliferation, and survival of mammary epithelial cells. In summary, our results suggest that Tsg101 is required for normal cell function of embryonic and adult tissues but that this gene is not a tumor suppressor for sporadic forms of breast cancer.


Assuntos
Proteínas de Ligação a DNA/fisiologia , Embrião de Mamíferos/citologia , Glândulas Mamárias Animais/citologia , Glândulas Mamárias Animais/fisiologia , Fatores de Transcrição/fisiologia , Animais , Diferenciação Celular/genética , Divisão Celular/genética , Sobrevivência Celular/genética , Embrião de Mamíferos/fisiologia , Complexos Endossomais de Distribuição Requeridos para Transporte , Células Epiteliais/fisiologia , Feminino , Morte Fetal/genética , Regulação da Expressão Gênica no Desenvolvimento , Transtornos da Lactação/genética , Glândulas Mamárias Animais/anormalidades , Neoplasias Mamárias Experimentais/genética , Camundongos , Camundongos Knockout , Camundongos Transgênicos
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