New Hampshire Osteopathic Association: Dr. Kirmes to Potential New Hampshire D.O.s

A letter from Dr. Kirmes to potential New Hampshire D.O.s recommending coming to New Hampshire to practice.https://dune.une.edu/kirmescollection/1108/thumbnail.jp

Playing Well With Others: Evaluating An Intervention To Prepare Students For Interprofessional Collaborative Learning

National trends in health care delivery focus on quality team-based care, patient safety, reducing costs and improving practitioner satisfaction (Interprofessional Education Collaborative, 2016). Health profession students, including social workers, are expected to be workforce ready for a complex interprofessional work environment. Educators are charged with developing effective ways to teach collaborative team skills as part of the curriculum (Rubin et al., 2018; Thistlethwaite et al., 2014). Educators across health professions recognize the importance of providing opportunities to immerse students in experiential, person-centered interprofessional teamwork to adequately prepare them for the workforce. (Cohen Konrad et al., 2017; Mokler, 2020). Planned interprofessional collaborative learning (ICPL) creates opportunities for students to develop mutual awareness and respect of each other’s profession and enhance students’ comfort working across disciplines (Dow et al., 2013; Congdon et al., 2020; Jones et al., 2020; Kanji et al., 2019; Peterson & Brommelsiek, 2017). The Council on Social Work Education (CSWE) acknowledged the importance of collaborative practice by becoming a supporting organization of the national Interprofessional Education Collaborative and the explicit addition of interprofessional collaborative competencies to the education standards expected of graduates from accredited social work programs. Thus, Social work educators are charged with providing opportunities for students to develop these competencies. Social workers bring a unique lens to the interprofessional healthcare team that is often misunderstood by other professions (de Saxe Zerden et al., 2018; Kobayashi & Fitzgerald, 2017). A barrier social work students encounter in ICPL is the lack of knowledge and biases and assumptions other health profession students and faculty have about the profession (Pecukonis et al., 2008; Pecukonis, 2014, 2020). Encountering negative stereotypes and bias as well as hierarchical attitudes can make it difficult for social work students to find their place and voice within the interprofessional team during ICPL and students are often unprepared to respond to this (Gergerich et al., 2019; Pecukonis, 2020). This dissertation research evaluated the effectiveness and efficacy of an intervention through a mixed methods study. The purpose of the intervention was to contextualize ICPL in social work education, explore benefits, challenges, and barriers to interprofessional teamwork, increase understanding of the role of social work on the healthcare team, and improve student self-efficacy for managing conflicts that may arise from professional centrism, stereotyping, hierarchical attitudes, and bias

Impact Of Intrathecal Morphine On Patient Outcomes In Major Abdominal Surgery

Colorectal enhanced recovery after surgery (ERAS) guidelines for patients undergoing major abdominal surgeries have started to include intrathecal morphine (ITM) as part of the protocol to improve patient outcomes. There is interest amongst other abdominal surgical disciplines in expanding the use of ITM. When used as a single bolus, ITM has shown to have an intravenous (IV) opioid sparing effect postoperatively, as well as improved pain scores for up to 24 hours (Koning et al., 2020). However, ITM coincides with unique considerations and side effects. There is a dose-dependent concern of ITM causing respiratory depression postoperatively that necessitates additional monitoring which should be considered with patient selection and dose (Gustafsson et al., 2019). Another less detrimental, albeit more common side effect, is a 30-60% increase in pruritus as compared to use of IV opioids (Wang et al., 2021). The intent of this literature review is to discuss the impact of ITM on pain scores and narcotic use across major abdominal surgery specialties, as well as postoperative side effects such as respiratory depression, pruritis, nausea, length of stay, and their impact on patient satisfaction. The mechanism of action and pharmacodynamics of ITM and how it compares to that of IV opioids will be reviewed

Perspectives Of First-Year Internal Medicine Residents On Evaluating Medical Students

As physicians-in-training transition from medical school to residency, they must quickly adapt to new environments, systems, and roles in the clinical education setting. Many are tasked with teaching and evaluating their near-peer medical students as early as the first day of residency training, yet they are often uninformed on teaching practices and assessment strategies. This basic qualitative study explored first-year medical resident perceptions of the influence of evaluating medical students on their transition from medical student to first-year resident. Nine first-year internal medicine residents participated in this study through semi-structured individual interviews. Four themes emerged from the data: 1) feeling responsible for the growth of third-year medical students, 2) concerns about the impact of subjective grades and evaluations, 3) unpreparedness to evaluate medical students, and 4) preparedness for the first year of residency. Through data analysis, the themes informed the following findings: first-year residents are uncertain if they should evaluate medical students, first-year residents prefer the role of near-peer mentor over evaluator, first-year residents are unprepared to evaluate medical students, first-year residents learn how to evaluate through social constructivism (Vygotsky, 1978), a supportive environment eases the transition to residency, and the first year of residency requires on-the-job learning. The results of this study suggest changes can be made in medical education to better support the learning environment and experiences for first-year medical residents

A Collaborative Case Report on Providing Interprofessional Holistic Care

A collaborative case report on providing interprofessional holistic care. Aims of the study include exploring opportunities for alternative medicine and utilizing patient-centered-care as a mechanism to promote self-empowerment.https://dune.une.edu/cecespring2023/1011/thumbnail.jp

NEFOM: What is an Osteopathic Physician Anyway?

A pamphlet entitled What is an Osteopathic Physician Anyway?https://dune.une.edu/kirmescollection/1075/thumbnail.jp

Recurrence And Metastasis Of Breast Cancer After Volatile Inhalation Agents For Primary Cancer Resection

Surgical resection of a breast tumor is frequently a treatment option for cancer, and in some cases can be curative (Hurtado et al., 2021). Multiple factors increase the risk of metastasis or recurrence including the neuroendocrine stress response to surgery and manipulation of the tumor itself (Kim, 2018). Additional factors include depression of cell-mediated immunity including sympathetic nervous system (SNS) stimulation, hypothalamic-pituitary-adrenal (HPA) axis stimulation, and pain (Hurtado et al., 2021). Research suggests that anesthetic selection, particularly total intravenous anesthesia versus volatile inhalation anesthesia (IA), has an impact on cancer recurrence and metastasis in breast cancer patients, however it remains unclear if one is superior to the other

Effects Of Intravenous Lidocaine Infusions On Postoperative Opioid Consumption In Adults Undergoing Laparoscopic Abdominal Surgery

Lidocaine is a local anesthetic that is often administered to surgical patients undergoing anesthesia. While it was originally utilized as an intravenous antiarrhythmic or for local infiltration, it is now frequently used for the proven opioid-sparing and anti-inflammatory effects during surgeries (Beaussier et al., 2018). A common complaint of postoperative patients is pain, and the administration of intravenous lidocaine can potentially decrease patients\u27 perception of pain after surgical procedures (Lee & Schraag, 2022). Opioids are commonly administered to patients to help control their pain immediately after surgical procedures. Though opioids are the typically chosen treatment for acute surgical pain, they can have significant side effects. As stated by Wei et al. (2019), opioid administration can lead to reduced gastric motility, postoperative nausea and vomiting, and increased length of hospital stay. These adverse effects can be minimized by using intravenous lidocaine as a part of multimodal anesthesia for pain management by decreasing opioid consumption. This study examines the effects of intravenous lidocaine on postoperative opioid use in patients undergoing laparoscopic abdominal surgery. Overall, intravenous lidocaine is proven to reduce postoperative pain scores and decrease perioperative opioid use

Effects of Digestion, Cell Culture Media, and Mucous on the Physical Properties, Cellular Effects, and Translocation of Polystyrene and Polymethacrylate Nanoparticles

The discovery of plastic and metal nanoparticles in organisms, foods, and beverages has generated numerous studies on the effects of these particles on the barrier cells and their subsequent absorption into the body. Following ingestion, nanoparticles travel down the gastrointestinal tract (GIT), and their physicochemical characteristics change in response to the change in proteins and pH during their digestion. We measured the translocation of digested nanoparticles across a co-culture monolayer of Caco-2 and various combinations (1:9, 5:5, and 9:1) of HT29-MTX-E12. The in vitro model of the intestine was used to determine the translocation of digested 20 nm polymethacrylate (PMA) particles and the accompanying monolayer barrier effects after a 72 h exposure. The in vitro digestion increased the agglomeration and hydrodynamic diameters and decreased the surface charge of the nanoparticles. For NH2-functionalized polymethacrylate nanoparticles (PMA-NH2), the diameters increased from 57 nm (water) to 3800 nm (media), or 2660 nm (chyme). These nanoparticles compromised the integrity of the monolayer (trans-epithelial electrical resistance, Lucifer yellow translocation) and translocated across all the cell ratio configurations. Digestion can have a large effect on nanoparticle agglomeration and surface charge. Excess mucous was not seen as a barrier to the translocation of PMA-NH2

Interprofessional Collaboration Addressing the Public Health Paradigm

The collaboration between COM, CMD, and DPT have come together to develop a case study example that addresses the social determinants of health within the Maine community. Using the public health problem solving-paradigm, we have discussed how health disparities and access to quality care play a key role in the outcomes of our patients. We discuss the psychosocial implications of health inequality and the community-based implications of rural medicine.https://dune.une.edu/cecespring2023/1003/thumbnail.jp