RESUMO
Establishing the effectiveness of IPE experiences is essential, and current assessment measures may be subject to various types of bias. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) is administered after the learning experience as retrospective pretest and posttest measures of perceived collaborative practice skills. Because the ICCAS does not have an actual pretest, there are potential risks of recall bias and social desirability bias. To address these concerns, Jackson (2017) proposed conducting a true ICCAS pretest before the learning experience and examining the differences between the true and retrospective pretest scores and the differences between these pretest and posttest scores. This study design was implemented for two in-person Interprofessional forums conducted in the Fall (N = 745) and following Spring (N = 599) semesters. Students from 11 (Fall) and 12 (Spring) health professions education programs were included. True ICCAS pretest scores did not significantly differ from the retrospective pretest scores in either sample, although the effect sizes for pretest to posttest gains were slightly smaller for the true pretest scores. These results support and provide confidence for using the standard ICCAS administration methodology by demonstrating the administration methodology is not adversely impacted by recall or social desirability biases.
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Relações Interprofissionais , Estudantes de Ciências da Saúde , Humanos , Estudos Retrospectivos , Inquéritos e Questionários , Competência ClínicaRESUMO
Measuring the effectiveness of interprofessional education (IPE) experiences is essential but challenging. Surveying learners before (pretest) and after (posttest) an IPE experience may result in minimal change due to response shift bias. Retrospective pretest/posttest assessment may ameliorate response shift bias but may also result in inflated change scores due to social desirability bias. We studied a cohort of 675 students from 12 health professions who completed the Interprofessional Attitudes Scale (IPAS) within the 4 weeks before (pretest) and the 3 weeks after (posttest) an IPE forum and completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) within the 3 weeks after the forum as a retrospective pretest/posttest. We found higher scores on the pretest IPAS than the retrospective pretest ICCAS and greater change in scores on the ICCAS than the IPAS, indicating potential response shift and social desirability biases. Furthermore, we found few significant correlations between change scores in subscales of the two tests, but a high number of strong and significant correlation among the ICCAS subscale change scores. Our results indicate the timing of pretest administration may impact change scores or that subscales of IPAS may be more unique than those of ICCAS. These findings suggest that educators should consider the potential impact of response shift and social desirability biases when interpreting results of the IPAS and ICCAS in response to an IPE learning experience.
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Ocupações em Saúde , Relações Interprofissionais , Humanos , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The research assessed online learning modules designed to teach health professions students evidence-based practice (EBP) principles in an interprofessional context across two institutions. METHODS: Students from nine health professions at two institutions were recruited to participate in this pilot project consisting of two online learning modules designed to prepare students for an in-person case-based interprofessional activity. Librarians and an instructional designer created two EBP modules. Students' competence in EBP was assessed before and after the modules as well as after the in-person activity. Students evaluated the online learning modules and their impact on the students' learning after the in-person session. RESULTS: A total of 39 students from 8 health professions programs participated in the project. Average quiz scores for online EBP module 1 and module 2 were 83% and 76%, respectively. Following completion of the learning modules, adapted Fresno test of competence in EBP scores increased (p=0.001), indicating that the modules improved EBP skill competence. Student evaluations of the learning modules were positive. Students indicated that they acquired new information skills that contributed to their ability to develop a patient care plan and that they would use these information skills in their future clinical practice. CONCLUSIONS: Online EBP learning modules were effective in developing EBP knowledge and skills for health professions students. Using the same modules ensured that students from different health professions at different stages of their professional programs had consistent knowledge and enabled each student to fully engage in an interprofessional evidence-based activity. Student feedback indicated the modules were valued and beneficial.
Assuntos
Prática Clínica Baseada em Evidências/educação , Aprendizagem Baseada em Problemas/métodos , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adulto , Currículo , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Ensino , Adulto JovemRESUMO
INTRODUCTION: Graphical representations of a case study can help learners recognize how systems and institutions impact health. The impact of the social determinants of health (SDoH) on individual and community health is well established, yet it may be challenging for students to visualize the impact of these components within a case study. PURPOSE: This study explored the use of ecomaps in an interprofessional forum and examined the perceptions from students and faculty regarding use of this educational tool. METHODS: This tool was assessed over two semesters, Fall 2021 (n=968) and Fall 2022 (n= 835) to evaluate student and faculty perceptions of the use of the tool along with faculty's assessment of student completion of the tool within a rubric. RESULTS: Nearly all students (99%) came prepared to the forum and presented their ecomaps to others during the small group discussion to facilitate conversation as they explored the role of SDoH related to the case study. Both students and faculty rated the use of this tool favorably. DISCUSSION: In conclusion, ecomaps were viewed favorably by both students and faculty. This visual exploration of SDoH helps students to visualize both positive and negative factors that impact a patient's experience.
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Docentes , Determinantes Sociais da Saúde , Humanos , Estudantes , ComunicaçãoRESUMO
BACKGROUND: Interprofessional (IP) socialization is important to develop early in the training of health professions students. PURPOSE: This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game ( Friday Night at the ER [FNER]). METHODS: The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing. RESULTS: IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development. CONCLUSIONS: An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.
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Socialização , Estudantes de Ciências da Saúde , Humanos , Relações Interprofissionais , Pesquisa em Educação em Enfermagem , Ocupações em Saúde/educaçãoRESUMO
BACKGROUND: This project investigated the change in nursing, pharmacy, and physical therapy students' interprofessional socialization after participation in a virtual interprofessional escape room and case conference simulation. INTERPROFESSIONAL EDUCATION ACTIVITY: Interprofessional teams of nursing (n = 93), pharmacy (n = 75) and physical therapy (n = 33) students completed asynchronous, online learning (sepsis recognition and total hip replacement post-operative precautions) followed by a virtual escape room and a virtual simulated patient case conference. During the case conference, interprofessional student teams developed a discharge plan for an individual after a hip replacement complicated by post-operative sepsis. Before and after the experience, students completed a knowledge test and a validated survey instrument that assessed their interprofessional socialization (Interprofessional Socialization and Valuing Scale-21). During the simulated patient case conference, faculty assessed student performance using a standardized rubric. After the experience students completed a program evaluation. DISCUSSION: Interprofessional socialization significantly increased (5.5 ± 0.9 vs. 6.0 ± 0.9) among all students with a medium effect size (Cohen's d = 0.56). Faculty assessment of individual student's team performance during the virtual simulation revealed a moderate rate meeting competency, with good interrater reliability. Students highly valued this learning experience as being both effective and important to their professional development, as indicated on the program evaluation. IMPLICATIONS: A virtual interprofessional experience consisting of asynchronous online learning, a virtual escape room, and a virtual case conference positively influenced students' interprofessional socialization. Students valued the experience and recognized its importance in their development as student health professionals.
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Farmácia , Estudantes de Ciências da Saúde , Humanos , Relações Interprofissionais , Reprodutibilidade dos Testes , AprendizagemRESUMO
Objective. The purpose of this study was to extend our understanding of escape room pedagogical design by investigating the impact of escape room puzzle content on changes in students' immediate recall knowledge and demonstration of interprofessional skills during a subsequent simulation.Methods. Students from nursing, pharmacy, and physical therapy programs were randomized to complete an escape room themed around acute management of sepsis (intervention group; n=133) or general acute care (control group; n=129) prior to participating in a simulated patient discharge case conference. Students completed a knowledge assessment before the escape room, immediately after the escape room, and immediately after the simulation. Additionally, students completed the Interprofessional Socialization and Valuing Scale (ISVS-21) before and after the experience along with a post-program evaluation. Faculty rated student achievement of interprofessional learning objectives during the simulation using a standardized rubric.Results. Students in the intervention group had higher scores on the knowledge test administered immediately after the escape room. All participants' ISVS-21 scores increased from before to after the activity. Interprofessional learning objectives, as evaluated by faculty, were met by 248 (94.7%) students.Conclusion. Participating in an interprofessional escape room activity with specific puzzle content improved students' immediate recall knowledge. In both groups, self-assessed interprofessional socialization improved, and a high percentage of students achieved the interprofessional learning objectives in a subsequent simulation. Escape rooms can be an innovative pedagogical tool that can positively impact immediate recall knowledge and interprofessional collaborative skills of health professions students.
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Educação em Farmácia , Estudantes de Ciências da Saúde , Estudantes de Enfermagem , Estudantes de Farmácia , Humanos , Educação em Farmácia/métodos , Relações Interprofissionais , Ocupações em SaúdeRESUMO
PURPOSE: This study evaluates third-year dental medicine students' perceived competencies related to interprofessional collaborative practice (IPCP) after completing two exposure level experiences with students from other professions across a large academic health center. METHODS: Two cohorts of D3 dental medicine students (2018-2019 and 2019-2020) completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) after participating in in-person 2.5-h Interprofessional (IP) Forums in the Fall and Spring semesters. Self-reported competencies were compared between pre-and post-IP Forum ratings and between Fall and Spring. RESULTS: Prior to the IP Forums, dental medicine students (n = 185) reported perceived skill in the interprofessional competencies to be from Good to Very Good using the ICCAS. After participation in the Fall IP Forum, students' ICCAS scores increased in all ICCAS subscales with large effect sizes. Students reported a perceived decline in these skills in the four months between Fall and Spring IP Forums and restoration of IP skill levels after participating in a second IP Forum (Spring). CONCLUSIONS: Participation in IP Forums has a positive impact on students' IPCP skill perception. Our data suggest that perceived skill level requires repeated IP learning experiences. If dental medicine students are expected to embrace collaborative practice to enhance patient outcomes, then dental school educators must provide opportunities for students to engage in collaborative practice experiences at all levels of their training.
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Relações Interprofissionais , Estudantes , Humanos , Percepção , Inquéritos e QuestionáriosRESUMO
Objective. To produce, implement, and evaluate the effectiveness of a film to develop the foundational knowledge and skills of health professions students and teach them the importance of interprofessional collaboration. Methods. An existing interprofessional case study about a Hispanic man suffering from multiple chronic health conditions and the impact his health had on his family served as the basis for the film. To ensure a high-quality production, faculty members partnered with a local theatre company to produce the film. Upon completion, the film was integrated into an annual interprofessional forum and evaluated by both students and faculty members in 2016, 2017, and 2018. Results. The 22-minute film, entitled Meet Fred Santiago: Improving Care Through Interprofessional Collaboration, was shown to 1921 students and 250 faculty members who participated in the interprofessional forum over the three years. Of these, 1858 students and 174 faculty members completed a program evaluation following the forum. The majority (>86%) of student and faculty respondents agreed or strongly agreed that the film presented a realistic view of the challenges faced by people with multiple chronic health problems. The majority of students (>85%) agreed or strongly agreed that the film helped them appreciate the breadth of issues confronting individuals with multiple chronic health problems. Conclusion. The film, Meet Fred Santiago, is an effective tool for introducing health professions students to the complex interrelationship of medical, psychological, and social issues experienced by individuals with chronic health conditions.
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Comportamento Cooperativo , Educação Profissionalizante , Relações Interprofissionais , Filmes Cinematográficos , Estudantes de Ciências da Saúde/psicologia , Ensino , Atitude do Pessoal de Saúde , Cuidadores , Efeitos Psicossociais da Doença , Drama , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapiaRESUMO
More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.
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Doença Crônica/reabilitação , Cuidados Críticos , Estado Terminal/reabilitação , Serviços de Assistência Domiciliar , Alta do Paciente , Modalidades de Fisioterapia , Betacoronavirus , COVID-19 , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/reabilitação , Infecções por Coronavirus , Humanos , Pandemias , Pneumonia Viral , SARS-CoV-2RESUMO
Matrix metalloproteinases (MMPs) modulate development, inflammation, and repair in lungs. Tissue inhibitors of MMPs (TIMPs) interact with MMPs, controlling the intensity and nature of the response to injury. Absence of MMP-9, -2, and -8 activities is associated with altered lung inflammation during allergic sensitization. To test the hypothesis that the absence of TIMP-1 enhances allergic lung inflammation, airway hyperreactivity (AHR), and lung remodeling in asthma, we studied TIMP-1 null (TIMP-1 KO) mice and their WT controls using an ovalbumin (OVA) asthma model. TIMP-1 KO mice, compared to WT controls, developed an asthma phenotype characterized by AHR, pronounced cellular lung infiltrates, greater reduction in lung compliance, enhanced Th2 cytokine mRNA and protein expression, and altered collagen lung content associated with enhanced MMP-9 activity. Our findings support the hypothesis that TIMP-1 plays a protective role by preventing AHR and modulating inflammation, remodeling, and cytokine expression in an animal model of asthma.
Assuntos
Asma/imunologia , Citocinas/imunologia , Pneumonia/imunologia , Inibidor Tecidual de Metaloproteinase-1/imunologia , Animais , Asma/induzido quimicamente , Citocinas/biossíntese , Modelos Animais de Doenças , Expressão Gênica , Hidroxiprolina/imunologia , Hidroxiprolina/metabolismo , Imunoglobulina E/sangue , Pulmão/imunologia , Pulmão/patologia , Camundongos , Camundongos Endogâmicos C57BL , Ovalbumina/imunologia , Pneumonia/patologia , RNA Mensageiro/imunologia , RNA Mensageiro/metabolismo , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-1/metabolismoRESUMO
INTRODUCTION: Faculty and preceptor development have been noted to be areas of need within the expansion of interprofessional education (IPE). The primary objective of this pilot study was to evaluate the impact of a preceptor development program on pharmacy preceptors' self-reported competence toward interprofessional collaboration. METHODS: Pharmacy preceptors were invited to participate in a two-hour preceptor development program followed by a brief survey. Preceptor development program objectives were to: define IPE and interprofessional collaborative practice (IPCP); describe the benefits of IPCP for patients/clients, healthcare providers, and health systems; discuss the four Interprofessional Education Collaborative (IPEC) Core Competencies; and describe IPE student experiences aimed at increasing collaborative practice. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) was administered after the preceptor development program. Descriptive statistics were used to characterize the data and paired t-tests were used to analyze pre-/post-program scores. RESULTS: Thirty (35%) preceptors completed the survey. Mean scores for all twenty items in the ICCAS instrument increased from pre- to post-(pâ¯<â¯0.05). The mean total ICCAS score pre- was 5.28⯱â¯1.12 and post- was 6.17⯱â¯1.11 (pâ¯<â¯0.01) out of a possible total score of seven. CONCLUSIONS: A preceptor development program targeting IPE and IPCP increased pharmacy preceptors' self-reported competence toward interprofessional collaboration.
Assuntos
Preceptoria/métodos , Estudantes de Farmácia/psicologia , Capacitação de Professores/métodos , Adulto , Competência Clínica/estatística & dados numéricos , Educação em Farmácia/normas , Docentes , Feminino , Pessoal de Saúde , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Farmácia , Projetos Piloto , Desenvolvimento de Programas , Autoeficácia , Autorrelato , Inquéritos e QuestionáriosRESUMO
Objective. To evaluate the impact of a large-scale interprofessional forum on pharmacy students' attitudes toward interprofessional collaborative practice. Methods. Pharmacy students were asked to complete the Interprofessional Attitudes Scale (IPAS) prior to and after completing a three-hour interprofessional forum. Scores for the total IPAS and each of the subscales were computed using the mean of students' responses to the items for each. Results. Of the 133 pharmacy students who participated in the forum, there were valid pre- and post-intervention matched IPAS data for 124 (93.2%). In general, prior to the forum, students reported positive attitudes toward interprofessional collaborative practice as demonstrated by mean scores greater than 4.0 (agree) on the total IPAS scale and on all of the IPAS subscales except the Interprofessional Biases subscale). There was a significant increase from pre- to post-intervention scores on all the subscales except Patient-Centeredness. Based on the Cohen d measure of effect size, the greatest changes were in the Teamwork, Roles and Responsibilities and Community-Centeredness subscales, followed by the Interprofessional Biases subscale and Diversity and Ethics subscale. Conclusion. Prior to participating in an interprofessional student forum, pharmacy students generally had positive attitudes toward interprofessional collaborative practice. After participating in the forum, these attitudes become even more positive. Interprofessional education interventions, such as the forum, play an important role in shaping student's attitudes toward interprofessional collaboration.
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Educação em Farmácia/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/psicologia , Estudantes de Farmácia/psicologia , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Humanos , Comunicação Interdisciplinar , Relações Interprofissionais , Assistência Farmacêutica/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Background: Post-intensive care syndrome (PICS) is a constellation of new or worsening impairments in physical, mental, or cognitive abilities or a combination of these in individuals who have survived critical illness requiring intensive care. Purpose: The 2 purposes of this systematic review were to identify the scope and magnitude of physical problems associated with PICS during the first year after critical illness and to use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to elucidate impairments of body functions and structures, activity limitations, and participation restrictions associated with PICS. Data Sources: Ovid MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL Plus with Full Text (EBSCO), Web of Science, and Embase were searched from inception until March 7, 2017. Study Selection: Two reviewers screened titles, abstracts, and full text to independently determine study eligibility based on inclusion and exclusion criteria. Data Extraction: Study methodological quality was assessed using the Newcastle-Ottawa Scale. Data describing study methods, design, and participant outcomes were extracted. Data Synthesis: Fifteen studies were eligible for review. Within the first year following critical illness, people who had received intensive care experienced impairments in all 3 domains of the ICF (body functions and structures, activity limitations, and participation restrictions). These impairments included decreased pulmonary function, reduced strength of respiratory and limb muscles, reduced 6-minute walk test distance, reduced ability to perform activities of daily living and instrumental activities of daily living, and reduced ability to return to driving and paid employment. Limitations: The inclusion of only 15 observational studies in this review may limit the generalizability of the findings. Conclusions: During the first year following critical illness, individuals with PICS experienced physical impairments in all 3 domains of the ICF.
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Atividades Cotidianas , Cuidados Críticos , Estado Terminal , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Qualidade de Vida , SíndromeRESUMO
INTRODUCTION: There is growing recognition that collaborative practice among healthcare professionals is associated with improved patient outcomes and enhanced team functioning, but development of collaborative practitioners requires interprofessional education (IPE). Immersive simulation, a clinically relevant experience that deeply engages the learner in realistic clinical environments, is used increasingly for IPE. The purpose of this study was to assess the use of immersive simulation as a strategy for IPE in physical therapist (PT) education programs. METHODS: During fall 2014 and spring 2015, we contacted all 214 Commission on Accreditation in Physical Therapy Education accredited PT education programs in the United States and invited a faculty member to participate in our online survey. RESULTS: One hundred fourteen PT programs responded (53% response rate). Eighty responding programs (70%) identified themselves as users of immersive simulation, and 45 programs (39%) used simulation for IPE. Of these 45 programs, more than 90% included Interprofessional Education Collaborative competency learning objectives of roles/responsibilities, interprofessional communication, and teams/teamwork and 51% reported learning objectives for values/ethics for interprofessional practice. Interprofessional simulations with PT students commonly included nursing (91%). In programs using immersive simulation for IPE, 91% included debriefing and 51% included debriefing by interprofessional teams. CONCLUSIONS: Eighty accredited PT programs (70%) that responded to the survey use immersive simulation, and 45 programs (39%) use simulation for IPE. Most programs conduct simulations consistent with recognized best practice, including debriefing and Interprofessional Education Collaborative competency learning objectives for promoting interprofessional collaborative practice. We anticipate an increase in the use of immersive simulation for IPE as an educational strategy to comply with the revised Commission on Accreditation in Physical Therapy Education accreditation standards related to interprofessional collaborative practice that will become effective on January 1, 2018.
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Comportamento Cooperativo , Pessoal de Saúde/educação , Relações Interprofissionais , Especialidade de Fisioterapia/educação , Treinamento por Simulação/estatística & dados numéricos , Competência Clínica , Processos Grupais , Humanos , Equipe de Assistência ao Paciente/organização & administração , Aprendizagem Baseada em ProblemasRESUMO
INTRODUCTION: Critical illness requiring intensive care unit (ICU) management is a life-altering event with â¼25% of ICU survivors experiencing persistent reductions in physical functioning, impairments in mental health, cognitive dysfunction and decreased quality of life. This constellation of problems is known as 'postintensive care syndrome' (PICS) and may persist for months and/or years. The purpose of this systematic review is to identify the scope and magnitude of physical problems associated with PICS during the first year after discharge from ICU, using the International Classification of Functioning, Disability and Health framework to elucidate the impairments of body functions and structures, activity limitations and participation restrictions. METHODS AND ANALYSIS: Medline (Ovid), Cochrane Database of Systematic Reviews (Ovid), Cochrane Central Register of Controlled Trials (Ovid), PubMed, CINAHL (EBSCO), Web of Science and EMBASE will be systematically searched for observational studies reporting the physical impairments of body functions and structures, activity limitations and participation restrictions associated with PICS. Two reviewers will assess the articles for eligibility according to prespecified selection criteria, after which an independent reviewer will perform data extraction which will be validated by a second independent reviewer. Quality appraisal will be performed by two independent reviewers. Outcomes of the included studies will be summarised in tables and in narrative format and meta-analyses will be conducted where appropriate. ETHICS AND DISSEMINATION: Formal ethical approval is not required as no primary data is collected. This systematic review will identify the scope and magnitude of physical problems associated with PICS during the first year after discharge from ICU and will be disseminated through a peer-reviewed publication and at conference meetings, to inform practice and future research on the physical problems associated with PICS. TRIAL REGISTRATION NUMBER: CRD42015023520.
Assuntos
Atividades Cotidianas , Disfunção Cognitiva , Estado Terminal , Saúde Mental , Qualidade de Vida , Humanos , Síndrome , Revisões Sistemáticas como AssuntoRESUMO
AGEs are a heterogeneous group of molecules formed from the nonenzymatic reaction of reducing sugars with free amino groups of proteins, lipids, and/or nucleic acids. AGEs have been shown to play a role in various conditions including cardiovascular disease and diabetes. In this study, we hypothesized that AGEs play a role in the "multiple hit hypothesis" of nonalcoholic fatty liver disease (NAFLD) and contribute to the pathogenesis of hepatosteatosis. We measured the effects of various mouse chows containing high or low AGE in the presence of high or low fat content on mouse weight and epididymal fat pads. We also measured the effects of these chows on the inflammatory response by measuring cytokine levels and myeloperoxidase activity levels on liver supernatants. We observed significant differences in weight gain and epididymal fat pad weights in the high AGE-high fat (HAGE-HF) versus the other groups. Leptin, TNF-α, IL-6, and myeloperoxidase (MPO) levels were significantly higher in the HAGE-HF group. We conclude that a diet containing high AGEs in the presence of high fat induces weight gain and hepatosteatosis in CD-1 mice. This may represent a model to study the role of AGEs in the pathogenesis of hepatosteatosis and steatohepatitis.
Assuntos
Fígado Gorduroso/metabolismo , Produtos Finais de Glicação Avançada/metabolismo , Inflamação/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Obesidade/metabolismo , Tecido Adiposo/fisiopatologia , Animais , Dieta Hiperlipídica , Fígado Gorduroso/genética , Fígado Gorduroso/patologia , Humanos , Inflamação/genética , Inflamação/patologia , Interleucina-6/biossíntese , Leptina/biossíntese , Fígado/metabolismo , Fígado/patologia , Camundongos , Hepatopatia Gordurosa não Alcoólica/genética , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade/genética , Obesidade/patologia , Oxirredução , Peroxidase/biossíntese , Fator de Necrose Tumoral alfa/biossíntese , Aumento de Peso/genéticaRESUMO
BACKGROUND AND PURPOSE: This investigation identified ventilation distribution, gas mixing, lung function, and arterial blood oxyhemoglobin saturation (SpO2) physiologic responses to 2 independent airway clearance treatments, high-frequency chest wall oscillation (HFCWO) and low positive expiratory pressure (PEP) breathing, for subjects who had cystic fibrosis (CF) and who were hospitalized during acute and subacute phases of a pulmonary exacerbation. SUBJECTS: Fifteen subjects with moderate to severe CF were included in this study. METHODS: Subjects performed single-breath inert gas tests and spirometry before and immediately after HFCWO and PEP breathing at admission and discharge. Arterial blood oxyhemoglobin saturation was monitored throughout each treatment. RESULTS: At admission and discharge, PEP breathing increased SpO2 during treatment, whereas HFCWO decreased SpO2 during treatment. Ventilation distribution, gas mixing, and lung function improved after HFCWO or PEP breathing. DISCUSSION AND CONCLUSION: High-frequency chest wall oscillation and PEP breathing are similarly efficacious in improving ventilation distribution, gas mixing, and pulmonary function in hospitalized people with CF. Because SpO2 decreases during HFCWO, people who have moderate to severe CF and who use HFCWO should have SpO2 monitored during an acute exacerbation.
Assuntos
Oscilação da Parede Torácica , Fibrose Cística/terapia , Respiração com Pressão Positiva , Adolescente , Gasometria , Feminino , Hospitalização , Humanos , Medidas de Volume Pulmonar , MasculinoRESUMO
BACKGROUND: Smoking is the leading preventable cause of chronic disease and premature morbidity. People with physical disabilities experience elevated smoking prevalence when compared with their non-disabled peers. The physical therapy profession is dedicated to meeting needs of people with physical disabilities, yet most physical therapists (PT) do not typically provide tobacco cessation interventions. Similar deficits exist among other health professions, creating a demand for improved services to address smoking-related health burdens. Within other health professions, insufficient tobacco cessation counseling (TCC) education has been linked to a lack of interventions and may account for similar deficits in physical therapy practice. STUDY PURPOSE: Goals were to assess feasibility, implementation, and results of a tailored TCC educational program for entry-level physical therapist (PT) students. SUBJECTS: Two cohorts of entry-level physical therapist (PT) students (n = 12 and n = 17). METHODS: Educational objectives were established based on prior review of the literature, a survey of national PT education programs, and clinical guidelines for TCC established by the United States Public Health Service (USPHS). Based on these objectives, the team designed a 3-hour workshop involving didactic content and problem-based skills practice. A pre- and post-test survey was used to measure 6 dimensions: knowledge, perceived barriers, perceived facilitators, self-efficacy, outcome expectations, and self-rated skill in TCC. Within each cohort, changes in score were compared using a paired t test. The ability to apply clinical guidelines for TCC was assessed using case scenarios and structured observation. These outcomes were selected based on the Theory of Reasoned Action, which states that future behavior is determined by intention to act. Intention to act is a product of knowledge, a positive balance between perceived barriers and facilitators, strong self-efficacy, favorable outcome expectations, and necessary skills. Student satisfaction with training was assessed through anonymous written feedback. Feasibility was based on cost analysis, including material resources, as well as faculty time and effort. RESULTS: Following participation, both cohorts improved in knowledge, perceived facilitators, outcome expectations, and self-rated skill. Cohort 2 also showed an increase in self-efficacy (P < .01). Structured observation revealed competencies in application of clinical guidelines for case-based scenarios. Mean student satisfaction ratings for the educational experience were 5/5, and cost-estimate for delivery of the 3-hour educational intervention was approximately $32 per student. CONCLUSIONS: This research study demonstrated feasibility and impact of an evidence-based curricular model designed to increase likelihood of TCC by future PTs by enhancing factors known to promote TCC behaviors. The program was well-received by students, and objectives were achieved through efficient use of faculty time and resources. Subsequent research should examine the effects of training on the provision of TCC within clinical settings, as well as the impact of TCC on smoking quit rates for patients who have received this intervention as a component of their physical therapy plan of care.
RESUMO
BACKGROUND AND PURPOSE: Individuals with cystic fibrosis (CF) have large amounts of infected mucus in their lungs, which causes irreversible lung tissue damage. Although patient-administered positive expiratory pressure (PEP) breathing has been promoted as an effective therapeutic modality for removing mucus and improving ventilation distribution in these patients, the effects of PEP on ventilation distribution and gas mixing have not been documented. Therefore, this preliminary investigation described responses in distribution of ventilation and gas mixing to PEP breathing for patients with moderate to severe CF lung disease. SUBJECTS AND METHODS: The effects of PEP breathing on ventilation distribution, gas mixing, lung volumes, expiratory airflow, percentage of arterial blood oxyhemoglobin saturation (SpO(2)), and sputum volume were studied in 5 patients with CF (mean age=18 years, SD=4, range=13-22) after no-PEP, low-PEP (10-20 cm H(2)O), and high-PEP (>20 cm H(2)O) breathing conditions. Single-breath inert gas studies and lung function tests were performed before, immediately after, and 45 minutes after intervention. Single-breath tests assess ventilation distribution homogeneity and gas mixing by observing the extent to which an inspired test gas mixes with gas already residing in the lung. RESULTS: Improvements in gas mixing were observed in all PEP conditions. By 45 minutes after intervention, the no-PEP group improved by 5%, the low-PEP group improved by 15%, and the high-PEP group improved by 23%. Slow vital capacity increased by 1% for no PEP, by 9% for low PEP, and by 13% for high PEP 45 minutes after intervention. Residual volume decreased by 13% after no PEP, by 20% after low PEP, and by 30% after high PEP. Immediate improvements in forced expiratory flow during the middle half of the forced vital capacity maneuver (FEF(25%-75%)) were sustained following high PEP but not following low PEP. DISCUSSION AND CONCLUSION: This study demonstrated the physiologic basis for the efficacy of PEP therapy. The results confirm that low PEP and high PEP improve gas mixing in individuals with CF, and these improvements were associated with increased lung function, sputum expectoration, and SpO(2). The authors propose that improvements in gas mixing may lead to increases in oxygenation and thus functional exercise capacity.