National Interprofessional Education Initiatives

Purpose: The goal of this presentation is to define the IPE activities that meet the national competencies and share strategies for designing, implementing, and assessing IPE programs. Background: According to the World Health Organization (WHO), interprofessional education is defined as students from 2 or more professions learning about, from, and with each other to enable effective collaborations and improve health outcomes. The institute of Medicine (IOM) reports that IPE must be included in the education and training of health care professionals to enhance the delivery of health care services. Most recently, many accrediting agencies have refined IPE to be Interprofessional Practice and Education. Accreditation Council for Pharmacy Education (ACPE) included IPE in the 2016 Accreditation Standards. Many colleges and schools of pharmacy have successfully developed and implemented IPE programs at their institutions. Description of Intervention: Faculty and administrators from various U.S. pharmacy programs will describe didactic and experiential IPE programs at their institutions. The presenters will share innovative examples of IPE programs and provide “lessons learned” for developing, implementing, and assessing IPE programs. Results: A group of academicians will highlight their national IPE initiatives to better meet the WHO framework, International Pharmaceutical Federation (FIP) Global Competencies, and ACPE standards. In addition, the presenters will describe innovative strategies for designing, implementing, and assessing the quality of IPE programs in various schools and colleges of pharmacy. Conclusions: Re-designing the education and training of health care professionals by including IPE will enhance the quality and safety of health care services, reduce costs, and improve health outcomes. Relevance to IPE or Practice: Initiatives used to design, implement, and assess various IPE programs can be applied to other healthcare disciplines delivering IPE. Educational and training outcomes of these initiatives can be mapped to national and global IPE standards to enhance the quality of pharmacy education. Learning Objectives: 1. Describe various national programs for designing, implementing, and assessing IPE. 2. Identify successful examples of IPE pharmacy programs applicable to other health care professions. 3. Share “lessons learned” for designing, implementing, and assessing IPE programs

Digging Deeper: Improving Health Communication with Patients

At the end of this activity, students will be able to: Identify five theories and models that can be used to facilitate the patient-provider health communication process Describe opportunities to optimize communication with patients in healthcare settings Apply health communication theories within patient care, providing specific approaches and language to utilizehttps://digitalcommons.chapman.edu/pharmacy_books/1026/thumbnail.jp

Nifedipine in Scleroderma Ulcerations

Cutaneous ulcerations may be due to a variety of causes, including vasculitis. infections, arterial insufficiency, and microvascular damage. The net effect is diminished blood flow to the skin. Nifedipine, a calcium antagonist, has been shown to improve cutaneous blood How and to alleviate reactive vasospastic ischemia (Raynaud's phenomenon). The authors report an ischemic ulcer of scleroderma showing visible improvement with nifedipine therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65515/1/j.1365-4362.1984.tb01233.x.pd

Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model

<p>Abstract</p> <p>Background</p> <p>Fully covered Self-Expanding metal stents (FCSEMS) have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct.</p> <p>Methods</p> <p>Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific). FCSEMS were kept in place for three months. At the end of the 3 months, FCSEMS were removed endoscopically. Five pigs were euthanized and their bile ducts harvested. The other five were kept alive for another month post removal. A single pathologist, created a scoring system (to determine degree of inflammation, fibrosis, and epithelial injury), examined all specimens in a blinded fashion.</p> <p>Results</p> <p>Four FCSEMS spontaneously migrated in the duodenum. On post mortem examination, mild mucosal thickness was noted in three bile duct specimens while superficial inflammation of the bile duct was noted in five animals. Histologic examination of the bile duct revealed focal acute inflammation in both groups. For the 5 animals euthanized immediately after stent removal, there was a tendency to have superficial mucosal erosion and fibrosis. In contrast, increased chronic inflammation was more commonly seen in the animals 1 month post stent removal, with all animals in this group showing moderate degrees of mononuclear inflammatory cell mucosal infiltrates. No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate.</p> <p>Conclusion</p> <p>FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement. Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.</p

Pharmacy Strategic Approaches for IPE Assessment

Purpose: The main goal of this presentation is to share pharmacy-specific strategies for assessing the structure, process, and outcomes of IPE programs. Background: An effective assessment plan includes evaluating each component of the IPE model: Structure, Process, and Outcomes. The structure of IPE contains curriculum, facilities, capacity, and technology. The process encompasses development of faculty/preceptors, in addition to engaging students, patients, and collaborative practices. And the outcomes comprise achieving the educational and clinical goals of an IPE program and meeting its vision and mission. There is a need to provide this critical information in a succinct format as a variety of accrediting bodies are expecting discipline specific assessment of IPE. Description of Intervention: Noting that a sound assessment plan should be developed prior to implementing interprofessional education (IPE) programs, the presenters will share successful strategies for evaluating students’ participation and patients’ engagement as partners in developing their care plans. Following a thorough literature review, examples of current tools used to assess the quality of educational and clinical outcomes of IPE programs will be presented. Results: Key IPE assessment tools have been identified and categorized based on the major components of the Kirkpatrick Evaluation Model: (1) reaction; (2a) attitude modification; (2b) knowledge and skill acquisition; (3) behavioral change; (4) change in organizational practice. These tools will be presented relative to their applicability to pharmacy education. Conclusions: It is vital for administrators and faculty to ensure that the mission, goals, and educational, behavioral, and clinical outcomes of IPE programs are met. Improvement initiatives must continually assess the quality of IPE programs. Relevance to interprofessional education or practice: The strategy used to identify and categorize assessment tools can be applied to other healthcare disciplines delivering IPE. These tools, relative to the Kirkpatrick evaluation model, map the specific learning objectives to the educational endeavors. Learning Objectives: 1. Describe a process for identifying assessment tools to utilize in the development of a programmatic IPE assessment plan. 2. Identify how utilizing the various assessment tools, per the Kirkpatrick evaluation model, can be applied to a programmatic curricular map. 3. Summarize “lessons learned” in assessing IPE in various pharmacy curricul

Interobserver agreement for single operator choledochoscopy imaging: can we do better?

Background. The SpyGlass Direct Visualization System (Boston Scientific, Natick, MA) is routinely used during single operator choledochoscopy (SOC) to identify biliary lesions or strictures with a diagnostic accuracy up to 88%. The objective of this study was to determine the interobserver agreement (IOA) of modified scoring criteria for diagnosing biliary lesions/strictures. Methods. 27 SPY SOC video clips were reviewed and scored by 9 interventional endoscopists based on published criteria that included the presence and severity of surface structure, vasculature visualization, lesions, and findings. Results. Overall IOA was slight for all variables. The K statistics are as follows: surface (K = 0.12, SE = 0.02); vessels (K = 0.14, SE = 0.02); lesions (K = 0.11, SE = 0.02); findings (K = 0.08, SE = 0.03); and final diagnosis (K = 0.08, SE = 0.02). The IOA for findings and final diagnosis was also only slight. The final diagnosis was malignant (11), benign (11), and indeterminate (5). Conclusion. IOA using the modified criteria of SOC images was slight to almost poor. The average accuracy was less than 50%. These findings reaffirm that imaging criteria for benign and malignant biliary pathology need to be formally established and validated

An interim report of the scleroderma clinical trials consortium working groups

© The Author(s) 2018. The Scleroderma Clinical Trials Consortium represents many of the clinical researchers in the world who are interested in improving the efficiency of clinical trials in systemic sclerosis. The Scleroderma Clinical Trials Consortium has established 11 working groups to develop and validate better ways of measuring and recording multiple aspects of this heterogeneous disease. These include groups working on arthritis, disease damage, disease activity, cardiac disease, juvenile systemic sclerosis, the gastrointestinal tract, vascular component, calcinosis, scleroderma renal crisis, interstitial lung disease, and skin measurement. Members of the Scleroderma Clinical Trials Consortium may join any one or more of these groups. Some of the working groups have only recently started their work, some are nearing completion of their mandated tasks, and others are in the midst of their projects. All these projects, which are described in this article, will help improve clinical trials and observational studies by improving or developing better, more sensitive ways of measuring various aspects of the disease. As Lord Kelvin stated, “To measure is to know. If you cannot measure it you cannot improve it.” The Scleroderma Clinical Trials Consortium is dedicated to improving the lives of patients with systemic sclerosis and it is our hope that the contributions of the working groups will be one important step in this process

Identification of fetal DNA and cells in skin lesions from women with systemic sclerosis

BACKGROUND: Systemic sclerosis is a disease of unknown origin which often occurs in women after their childbearing years. It has many clinical and histopathological similarities to chronic graft-versus-host disease. Recent studies indicate that fetal stem cells can survive in the maternal circulation for many years post partum. This finding suggests that fetal cells persisting in the maternal circulation or tissues could be involved in the pathogenesis of systemic sclerosis by initiating a graft-versus-host reaction. METHODS: We used the polymerase chain reaction (PCR) to identify Y-chromosome sequences in DNA extracted from peripheral-blood cells and skin lesions from women with systemic sclerosis of recent onset. To confirm the PCR findings, we used fluorescence in situ hybridization of peripheral-blood cells and cells within chronic inflammatory-cell infiltrates in biopsy specimens of affected skin. RESULTS: Y-chromosome sequences were found in DNA from peripheral-blood cells in 32 of 69 women with systemic sclerosis (46 percent), as compared with 1 of 25 normal women (4 percent, P\u3c0.001), and in T lymphocytes from 3 women with systemic sclerosis who had male offspring. Furthermore, Y-chromosome sequences were identified in skin-biopsy specimens from 11 of 19 women with systemic sclerosis (58 percent); 9 of the 11 were known to have carried male fetuses. Nucleated cells containing Y chromosomes were detected by fluorescence in situ hybridization in paraffin-embedded sections of skin lesions from all seven women we tested whose skin-biopsy specimens contained Y-chromosome sequences. CONCLUSIONS: Fetal antimaternal graft-versus-host reactions may be involved in the pathogenesis of systemic sclerosis in some women

Role of Fluorescent In Situ Hybridization, Cholangioscopic Biopsies, and EUS‐FNA in the Evaluation of Biliary Strictures

Background and Aims: Our goal was to compare the diagnostic accuracy of FISH in the detection of malignancy compared with other standard diagnostic modalities, including brush cytology and biopsy specimens over a 10-year period of prospective data collection. Methods: We conducted a review of all consecutive biliary strictures evaluated between 2006 and 2016. Patients with a final pathologic diagnosis or conclusive follow-up were included. We evaluated the performance of FISH polysomy (CEP 3, 7, and 17) and 9p21 deletion as well as cholangioscopic biopsy (CBx) and EUS-FNA. Statistical analysis was performed with the Mann–Whitney U and Fisher’s exact tests. Results: Of 382 patients with indeterminate strictures, 281 met inclusion criteria. Forty-nine percent were malignant. Cytology, FISH polysomy, and FISH polysomy/9p21 showed a specificity of 99.3%. FISH polysomy/9p21 as a single modality was the most sensitive at 56% (p < 0.001). The sensitivity of FISH polysomy/9p21 and cytology was significantly higher than cytology alone at 63 versus 35% (p < 0.05). EUS-FNA for distal strictures and CBx for proximal strictures increased sensitivity from 33 to 93% (p < 0.001) and 48–76% (p = 0.05) in cytology-negative strictures. Conclusions: The high specificity of FISH polysomy/9p21 suggests that a positive result is sufficient for diagnosing malignancy in indeterminate strictures. The significantly higher sensitivity of FISH polysomy/9p21 compared to cytology supports the use of FISH in all non-diagnostic cases. Although both EUS-FNA and CBx were complimentary, our results suggest that distal strictures should be evaluated by EUS initially. Proximal strictures may be evaluated by FISH first and then by CBx if inconclusive

Single Cell RNA Sequencing Identifies HSPG2 and APLNR as Markers of Endothelial Cell Injury in Systemic Sclerosis Skin

Objective: The mechanisms that lead to endothelial cell (EC) injury and propagate the vasculopathy in Systemic Sclerosis (SSc) are not well understood. Using single cell RNA sequencing (scRNA-seq), our goal was to identify EC markers and signature pathways associated with vascular injury in SSc skin.Methods: We implemented single cell sorting and subsequent RNA sequencing of cells isolated from SSc and healthy control skin. We used t-distributed stochastic neighbor embedding (t-SNE) to identify the various cell types. We performed pathway analysis using Gene Set Enrichment Analysis (GSEA) and Ingenuity Pathway Analysis (IPA). Finally, we independently verified distinct markers using immunohistochemistry on skin biopsies and qPCR in primary ECs from SSc and healthy skin.Results: By combining the t-SNE analysis with the expression of known EC markers, we positively identified ECs among the sorted cells. Subsequently, we examined the differential expression profile between the ECs from healthy and SSc skin. Using GSEA and IPA analysis, we demonstrated that the SSc endothelial cell expression profile is enriched in processes associated with extracellular matrix generation, negative regulation of angiogenesis and epithelial-to-mesenchymal transition. Two of the top differentially expressed genes, HSPG2 and APLNR, were independently verified using immunohistochemistry staining and real-time qPCR analysis.Conclusion: ScRNA-seq, differential gene expression and pathway analysis revealed that ECs from SSc patients show a discrete pattern of gene expression associated with vascular injury and activation, extracellular matrix generation and negative regulation of angiogenesis. HSPG2 and APLNR were identified as two of the top markers of EC injury in SSc