Interprofessional education - a case for Gerodontology training.

Increasing life expectancy, concepts of patient well-being, and the multiplicity of needs of the geriatric population, demand contribution, and collaboration of physicians, dentists, psychologists, pharmacists, and other allied health disciplines, to provide quality care to patients. Interprofessional education (IPE) is an approach to education that improves collaboration among health professionals and it can aid in better management of geriatric patients. Communication and cooperation affect health care performance and hence, influence patient outcomes. Currently, each of the disciplines mentioned has customized undergraduate and/or postgraduate training in geriatric care. Though a uni-disciplinary educational approach increases knowledge and skills of individual professions separately, IPE offers significant advantages. IPE seeks to have students learning together, as well as from each other to develop exemplary collaborative practice. The World Health Organization (WHO) has proposed that IPE will ensure optimum health care. However, IPE is yet to find its proper place in dental education. It would help dental students to develop a positive attitude toward geriatric patients and increase their empathy and efficiency in the management of these patients. This manuscript seeks to highlight the concept of interprofessional education (IPE) in gerodontology and develop recommendations for implementation of IPE in India.

Simulation-based assessment in anesthesia: an international multicentre validation study.

PURPOSE: Simulated clinical events provide a means to evaluate a practitioner's performance in a standardized manner for all candidates that are tested. We sought to provide evidence for the validity of simulation-based assessment tools in simulated pediatric anesthesia emergencies. METHODS: Nine centres in two countries recruited subjects to participate in simulated operating room events. Participants ranged in anesthesia experience from junior residents to staff anesthesiologists. Performances were video recorded for review and scored by specially trained, blinded, expert raters. The rating tools consisted of scenario-specific checklists and a global rating scale that allowed the rater to make a judgement about the subject's performance, and by extension, preparedness for independent practice. The reliability of the tools was classified as "substantial" (intraclass correlation coefficients ranged from 0.84 to 0.96 for the checklists and from 0.85 to 0.94 for the global rating scale). RESULTS: Three-hundred and ninety-one simulation encounters were analysed. Senior trainees and staff significantly out-performed junior trainees (P = 0.04 and P < 0.001 respectively). The effect size of grade (junior vs senior trainee vs staff) on performance was classified as "medium" (partial η2 = 0.06). Performance deficits were observed across all grades of anesthesiologist, particularly in two of the scenarios. CONCLUSIONS: This study supports the validity of our simulation-based anesthesiologist assessment tools in several domains of validity. We also describe some residual challenges regarding the validity of our tools, some notes of caution in terms of the intended consequences of their use, and identify opportunities for further research.

Preference of the place of death among people of pune.

AIM: Provision of end-of-life care requires that we have adequate information about the preferred place of death in the population. Since no such study is reported in India, this study was taken up in and around Pune, a large cosmopolitan city. SETTING AND DESIGN: A questionnaire was designed in three parts and distributed among the people above the age of 18 in and around Pune. MATERIALS AND METHODS: The questionnaire had three parts the first being a consent form, followed by one for collection of personal information and lastly questions specific to the subject matter. Filled forms were screened for inconsistencies, gaps of information and errors. RESULTS: The population survey was mixed, both urban and rural, men and women, educated and uneducated, young and old. Despite this heterogeneity, the results were consistent to the point that most of the people surveyed preferred home as the place of death. This preference cuts across all barriers, the only difference being that women had a stronger preference for home death compared to men. CONCLUSIONS: Helping people to die at their preferred place is a part of end-of-life care. Majority of people surveyed by us, prefer to die at home, where they are relatively more comfortable. Public and governmental policies should be directed toward facilitating home deaths.

Stress among Care Givers: The Impact of Nursing a Relative with Cancer.

AIMS: The aim of the present study is to assess the level and areas of stress among care givers nursing their loved ones suffering from cancer. SETTING AND DESIGN: An assessment of care givers' stress providing care to cancer patients at Cipla Palliative Care Center was conducted. The study involves data collection using a questionnaire and subsequent analysis. MATERIALS AND METHODS: A close-ended questionnaire that had seven sections on different aspects of caregivers' stress was developed and administered to 137 participants and purpose of conducting the survey was explained to their understanding. Caregivers who were willing to participate were asked to read and/or explained the questions and requested to reply as per the scales given. Data was collected in the questionnaires and was quantitatively analyzed. RESULTS: The study results showed that overall stress level among caregivers is 5.18 ± 0.26 (on a scale of 0-10); of the total, nearly 62% of caregivers were ready to ask for professional help from nurses, medical social workers and counselors to cope up with their stress. CONCLUSION: Stress among caregivers ultimately affects quality of care that is being provided to the patient. This is also because they are unprepared to provide care, have inadequate knowledge about care giving along with financial burden, physical and emotional stress. Thus interventions are needed to help caregivers to strengthen their confidence in giving care and come out with better quality of care.

Migration of a thoracic epidural catheter into the intercostal space via the intervertebral foramen.

We describe a documented migration of a thoracic epidural catheter into the thoracic cage in a 5-wk-old with DiGeorge's syndrome and an uncorrected acyanotic Tetralogy of Fallot who underwent laparotomy for malrotation, gastric fundoplication, and gastrostomy tube insertion under combined general and epidural anesthesia. A 20-gauge stimulating catheter was inserted caudally and advanced cephalad to the thoracic level while applying a low electrical current (1-10 mA) to confirm epidural placement at approximately T5-6. Despite good pain control through the third postoperative day, using an epidural infusion of bupivacaine 0.1% at 1-1.2 mL/h, radiography demonstrated catheter migration into the seventh intercostal space.

Fallopian tube carcinoma.

Primary adenocarcinoma of Fallopian tube is a rare gynecological malignancy affecting women in the fifth and sixth decades of their lives. The rarity of this type of carcinoma has prompted reports of individual cases rather than publication of a large series. One such case is reported in a 50-year-old nulliparous post-menopausal female. The age, low fertility index and presentation of the disease are in accordance with previous reports in the literature. The present case also fulfills the diagnostic criteria's applied to this tumor.

Hypersensitivity pneumonitis-like granulomatous lung disease with nontuberculous mycobacteria from exposure to hot water aerosols.

OBJECTIVE: Human activities associated with aerosol-generating hot water sources are increasingly popular. Recently, a hypersensitivity pneumonitis (HP)-like granulomatous lung disease, with non-tuberculous mycobacteria from exposure to hot water aerosols from hot tubs/spas, showers, and indoor swimming pools, has been described in immunocompetent individuals (also called "hot tub lung"). Our objective in this study was to examine four additional cases of hot tub lung and compare these cases with others reported in the English print literature on this disease. DATA SOURCES AND EXTRACTION: We retrospectively reviewed all cases (n = 4) of presumptively diagnosed hot tub lung in immunocompetent individuals at the various physician practices in Springfield, Illinois, during 2001-2005. In addition, we searched MEDLINE for cases of hot tub lung described in the literature. DATA SYNTHESIS: We summarized the clinical presentation and investigations of four presumptive cases and reviewed previously reported cases of hot tub lung. CONCLUSIONS: There is a debate in the literature whether hot tub lung is an HP or a direct infection of the lung by nontuberculous mycobacteria. Primary prevention of this disease relies on ventilation and good use practices. Secondary prevention of this disease requires education of both the general public and clinicians to allow for the early diagnosis of this disease.

Semen quality of industrial workers occupationally exposed to chromium.

A total of sixty-one subjects occupationally exposed to chromium in an industry which manufactures chromium sulphate and fifteen control subjects from a nearby industry which does not manufacture any chromium related compounds were studied. The history of each subject was recorded on pre-designed form through interview and a routine medical examination was carried out. Blood samples (5-6 ml) were collected for the estimation of chromium and semen samples were collected for semen analysis and the determination of copper and zinc levels in the seminal plasma. Clinical examination revealed nasal perforation in 10 subjects (out of 61) in the exposed group as compared to none in the control group. A significantly higher level of chromium was observed in the blood of the exposed workers as compared to the control. The concentration of zinc in seminal plasma was lower while the level of copper was higher in the exposed group as compared to the control. However, these changes were not statistically significant. Statistically significant higher numbers of morphologically abnormal sperms were noticed in the exposed group with respect to the control. Further analysis of the data indicated that about 53% of the exposed subjects showed less than 30% normal forms as compared to 10% in control subjects. However, no significant alterations in semen volume, liquefaction time, mean pH value, sperm viability, concentration or motility, were noticed between chromium exposed and unexposed workers. The data also indicates that exposure to chromium has some effect on human sperm as a significant positive correlation (r=0.301) was observed between percentages of abnormal sperm morphology and blood chromium levels (p=0.016) after pooling all the data of the control and exposure groups.

Effects of industrial pollution on respiratory morbidity among female residents of India.

The authors evaluated the respiratory symptoms and pulmonary function test results (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and ratio of FEV1 to FVC [FEV1%]) of female residents of the critically polluted industrial estate of Vapi, Gujarat (state), India, and compared these with control information derived from a village 20 km away. The authors categorized the studied residents as living in Vapi, in town, or in villages proximal to the Gujarat Industrial Development Corporation; living 2 to 3 km away from Vapi; living 3 to 5 km away from Vapi; and being in the control group. The authors found no significant association between respiratory symptoms and pulmonary function among Vapi residents. However, the obstructive type of abnormality was most predominant and significantly different among Vapi residents. The restrictive type was highly prevalent among residents living 2 to 3 km away from Vapi compared with the control group. These results suggest significant respiratory morbidity among residents that was associated with age and distance from the development corporation.