Interprofessional training for nursing and medical students in Norway : exploring different professional perspectives.

This article presents an explorative case study focusing on interprofessional training for medical and nursing students in Norway. Based on interviews with, and observations of, multiple stakeholder groups-students, university faculty, and hospital staff-content analysis was applied to investigate their perspectives regarding the design of such educational training. The findings revealed a positive perspective amongst stakeholders while voicing some concerns related to how communication issues, collaboration, workflow, and professional role patterns should be reflected in such training. Based on our data analysis we derive three themes that must be considered for successful interprofessional training of nursing and medical students: clinical professionalism, team performance, and patient-centered perspective. These themes must be balanced contingent on the students' background and the learning objectives of future interprofessional training efforts

Ala54Thr Fatty Acid-Binding Protein 2 (FABP2) Polymorphism in Recurrent Depression: Associations with Fatty Acid Concentrations and Waist Circumference

BACKGROUND: Fatty acid (FA)-alterations may mediate the mutual association between Major Depressive Disorder (MDD) and cardiovascular disease (CVD). However, etiology of observed FA-alterations in MDD and CVD remains largely unclear. An interesting candidate may be a mutation in the fatty acid-binding protein 2 (FABP2)-gene, because it regulates dietary FA-uptake. Therefore, we aimed to test the hypotheses that in MDD-patients the FABP2 Ala54Thr-polymorphism would be (I) more prevalent than in sex- and age-matched controls, (II) associated with observed alterations in FA-metabolism, and (III) associated with CVD-risk factor waist circumference. METHODS: We measured concentrations of 29 different erythrocyte FAs, FABP2-genotype, and waist circumference in recurrent MDD-patients and matched never-depressed controls. RESULTS: FABP2-genotype distribution did not significantly differ between the 137 MDD-patients and 73 matched controls. However, patients with the Ala54Thr-polymorphism had (I) higher concentrations of especially eicosadienoic acid (C20:2ω6; P=.009) and other 20-carbon FAs, and associated (II) lower waist circumference (P=.019). In addition, FABP2-genotype effects on waist circumference in patients seemed (I) mediated by its effect on C20:2ω6, and (II) different from controls. CONCLUSIONS: Although Ala54Thr-polymorphism distribution was not associated with recurrent MDD, our results indicate that FABP2 may play a role in the explanation of observed FA-alterations in MDD. For Ala54Thr-polymorphism patients, potentially adaptive conversion of increased bioavailable dietary precursors into eicosadienoic acid instead of arachidonic acid might be related to a low waist circumference. Because this is the first investigation of these associations, replication is warranted, preferably by nutrigenetic studies applying lipidomics and detailed dietary assessment

Oral platelet gel supernatant plus supportive medical treatment versus supportive medical treatment in the management of radiation-induced oral mucositis: a matched explorative active control trial by propensity analysis

OBJECTIVES:: In this active control trial, the rate of radio-induced WHO grade 3/4 oral mucositis and the change in quality of life, assessed by OMWQ-HN, were measured in subjects with head and neck cancer treated by platelet gel supernatant (PGS) and supportive medical treatment versus subjects treated by supportive medical treatment alone. MATERIALS AND METHODS:: Eighty patients with nonmetastatic head and neck cancer underwent curative or adjuvant radiotherapy. All patients underwent supportive medical treatment and/or PGS at the beginning and during radiotherapy. Sixteen patients received PGS in association with supportive medical treatment. To obtain 2 groups virtually randomized for important clinical characteristics subjects were matched, by propensity analysis, with a group of subjects (64 patients) treated with supportive medical treatment alone. RESULTS:: Subjects treated with standard supportive treatment experienced significant higher WHO grade 3/4 toxicity (55%; 35/64) than subjects treated by PGS (13%; 3/16). The reduced toxicity found in PGS group paralleled with the evidence that they developed later symptoms with respect to controls. The Cox proportional hazard model indicated that patients treated with standard supportive medical treatment experienced 2.7-fold increase (hazard ratio=2.7; 95% confidence interval, 1.3-5.7) in the occurrence of WHO grade 3/4 toxicity. PGS group significantly experienced higher quality of life than control groups as measured by OMWQ-HN. A significant decrease in the opioid analgesics usage was found in the PGS group. CONCLUSIONS:: These preliminary data should be interpreted with caution and could serve as a framework around which to design future trials

Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

BACKGROUND Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. METHODS A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. RESULTS We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. CONCLUSIONS Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.We also thank the Dutch Ministry of Health for funding the collection and videotaping of routine GP consultations

The Ghent Psychotherapy Study (GPS) on the differential efficacy of supportive-expressive and cognitive behavioral interventions in dependent and self-critical depressive patients : study protocol for a randomized controlled trial

Background: Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology. Methods/design: This study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1: 1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16-20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16-20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs. Discussion: This trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients

Users as inventors and developers of radical innovation: An explorative case study analysis in the field of medical technology

Our study focuses on the question, whether users should be intensively involved in the innovation process of radical product innovations or better not - from the manufacturer's perspective. Radical innovations incorporate new technologies, shift market structures, require intensive user learning and induce significant behavior changes. Due to these specifics the question arises, whether users play a productive role in the innovation process of radical innovations at all, or if their contributions might even be counterproductive. To gain a better understanding for the users' role in radical innovation and to develop a differentiated view of their contributions, we have studied three dimensions of user involvement were studied: (1) Which characteristics enable users to contribute to the innovation process? (2) How do manufacturers need to interact with users to benefit from their contributions? (3) How does user involvement impact on the manufacturer? We focused our study on the early phases of the innovation process. Two phases were distinquished for the analysis of these questions: Idea gen-eration and development. This distinction allows us to analyse the role of users within separate phases of the innovation process. Based on relevant theories and empirical work a set of propositions was formulated for each dimension. To study the addressed research questions, an explorative case study analysis was conducted in the field of medical technology. Five radical innovation projects were selected including medical robots, navigation systems, and biocompatible implants. In-depth inter-views were conducted with marketing, R&D, project leaders, CEO's, and users. A content analysis framework was applied to systematically analyse the collected data. The case studies reveal that users with a unique set of characteristics (motivation, competencies, contextual factors) were able to deliver major contributions in all three phases of the radical innova-tion projects. In four cases users turned out to be the original inventor of the radical innovations. Particularly users that work under extreme conditions (e.g. neurosurgeons) prooved to be a valuable source for radically new ideas. Furthermore the cases show that the innovative users took over classi-cal functions of manufacturers in the development process. For example the innovative users identified relevant experts and manufacturers that were required to transform their ideas into prototypes and products. These users therefore took over the networking function. some users were able to actively contribute to the development of first prototypes. A unique set of characteristics enabled users to do so. With regard to appropriate patterns of interaction between users and manufacturers the analysis reveals that face-to-face-interactions are required. This is due to the nature of information that is transferred. The information provided by users and by manufacturers is highly complex. Therefore explanations and visualisations are needed to gain an understanding on either side. In addition the analysis shows that it seems to be appropriate to interact with a small, well selected number of users in early phases and to increase the number of involved users as the project gets closer to market introduc-tion. In four cases specific users contributed significantly to NPD success. Based on the results of the study, the recommendation for manufacturers is to leverage the knowledge of users with certain char-acteristics for radical innovation projects. The results of our study form the basis of a market research concept for radical innovations. --innovation process,product innovation

Post- and peritraumatic stress in disaster survivors: An explorative study about the influence of individual and event characteristics across different types of disasters

Background: Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards. Objective: To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters. Additionally, to investigate individual and event characteristics. Design: In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event. Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R). Peritraumatic emotional stress and risk perception were rated retrospectively. Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed. Results: Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters. Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes. Conclusion: Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters. However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics. As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables

Primary Health Care Nurses’ Experiences of treating Children with Atopic Eczema in Gauteng, South Africa

Abstract: The prevalence of atopic eczema has increased in most African countries, including South Africa. Most patients with allergic conditions are seen by non-allergy trained healthcare workers, a situation that is also true for South Africa. The aim of this study was to explore and describe the experiences of primary health care (PHC) nurses in managing children with atopic eczema in a district of Gauteng. Methods: A qualitative, explorative, descriptive, contextual design with phenomenology approach was used. The study population included nurses in PHC clinics in Gauteng who were selected by purposive sampling method. Data saturation determined the sample size, which occurred after three focus group discussions and four in-depth individual interviews. Data was analysed according to Tesch’s steps of qualitative data analysis. Lincoln and Guba’s model for trustworthiness and the ethical measures employed according to the Medical Research Council for South Africa..

Characteristics of Pili Hemaglutinin Protein and Its Role in the Pathogenesis of Urinary Tract Infection with Uropathogenic Escherichia Coli

Urinary tract infection (UTI) is one of the most common infectious diseasesencountered in the community. The bacteria most frequently implicated as the causes ofUTI are the Gram-negative bacteria, especially Escherechia coli. Early phase of thepathogenesis of the infection constitutes adhesion of bacteria onto the epithelial cells ofurinary tract. SDS-PAGE examination was carried out to investigate molecule ofhemagglutinin protein and hemagglutination (HA) test continued by adhesion andinhibited adhesion tests.The observation of molecular weight of pili E. coli protein molecule byexplorative examination using SDS-PAGE showed on E. coli strip that the mostprominent molecular weights (MW) of the proteins were 61 kDa, 37 kDa, 30 kDa, and 20kDa. Purification by electro-elusion was done to proteins of the MW of 20 kDa, 37 kDaand 61 kDa. The HA test results indicated the 61 kDa, 37 kDa, and 20 kDa werehemagglutinin proteins and one which subsequently applied as sub unit proteins ofUropathogenic E. coli (UPEC) was the 37 kDa. Adhesion test of UPEC bacteria carriedout on urinary bladder epithelial cells of rabbit showed a significant correlation betweenadhesion index and various doses of subunit proteins of UPEC 37 kDa as coat of urinarybladder epithelial cells. Spearman rank correlation test and regression/non regressionanalysis confirmed an exponential decrease of UPEC adhesion to urinary tract epithelialcells as a response to the increasing doses of coating protein. This finding points out thatpili hemagglutinin protein subunit of UPEC 37 kDa was an adhesive molecule. Pilihemagglutinin protein subunit of UPEC 37 kDa is an adhesive molecule, which plays arole in adherence of UPEC to epithelial cells of urinary bladder at the early pathogenesisof urinary tract infection

Medical students' cognitive load in volumetric image interpretation:Insights from human-computer interaction and eye movements

Medical image interpretation is moving from using 2D- to volumetric images, thereby changing the cognitive and perceptual processes involved. This is expected to affect medical students' experienced cognitive load, while learning image interpretation skills. With two studies this explorative research investigated whether measures inherent to image interpretation, i.e. human-computer interaction and eye tracking, relate to cognitive load. Subsequently, it investigated effects of volumetric image interpretation on second-year medical students' cognitive load. Study 1 measured human-computer interactions of participants during two volumetric image interpretation tasks. Using structural equation modelling, the latent variable 'volumetric image information' was identified from the data, which significantly predicted self-reported mental effort as a measure of cognitive load. Study 2 measured participants' eye movements during multiple 2D and volumetric image interpretation tasks. Multilevel analysis showed that time to locate a relevant structure in an image was significantly related to pupil dilation, as a proxy for cognitive load. It is discussed how combining human-computer interaction and eye tracking allows for comprehensive measurement of cognitive load. Combining such measures in a single model would allow for disentangling unique sources of cognitive load, leading to recommendations for implementation of volumetric image interpretation in the medical education curriculum