The Indiana University Student Outreach Clinic as a Substrate for Interprofessional Education: A Physical Therapy Perspective

poster abstractPurpose The World Health Organization defines Inter-Professional Education (IPE) as “two or more professions learning about, from and with each other to enable effective collaboration &improve health outcomes.” IPE is being stressed in education to prepare students for Inter-Professional Care (IPC). IPC occurs when multiple health workers from different professional backgrounds provide comprehensive health services. Our purpose is to discuss the Indiana University Student Outreach Clinic (IU-SOC) as an exemplar in IPE/IPC in preparing PT students for clinical practice. Description The IU-SOC has implemented IPE/IPC by collaborating with partners from the schools of medicine, pharmacy, law, social work, dentistry, and most recently, physical therapy. Student leaders collaborate to provide comprehensive patient care. Different committees are in place to facilitate communication between disciplines. One PT student is designated in the IPE role to assist other partners in determining if a patient is appropriate for PT. This model has allowed PT to communicate reciprocally with medicine to ensure best patient care. Summary of Use IU-SOC is unique because it is a student-run pro bono clinic where teaching IPE/IPC is a primary purpose. Students benefit from this model by learning the importance of communication between disciplines early in their education to better prepare for IPC; making them more likely to utilize it during clinical practice. The community has increased access to services and is utilizing healthcare resources more efficiently, with less reliance on emergency services. Occupational Therapy is anticipated to join rehab services in the near future. Importance to Members IPC helps to sustain the health care system, improve outcomes, enhance organizational efficiency, and provide more comprehensive care. IPC is the future of health care; the foundation of which must be established in education. Multi-disciplinary, student-led outreach clinics, such as IU-SOC, can serve as an IPE/IPC substrate to prepare PT students for practice

Persistent dermatomal eruption on a leg

Unilateral linear capillaritis (ULC) is a rare variant of pigmented purpuric dermatoses (PPD) that is characterized by a linear or pseudo-dermatomal eruption on a single extremity. Although clinically distinct from the other PPD, it shares histopathologic features with this group. Herein, we present a man in his 50s who presented with asymptomatic macules and scaly papules on the left lower extremity in a linear distribution. The eruption persisted despite treatment with topical triamcinolone 0.1% and oral rutocide

The role of hole transport between dyes in solid-state dye-sensitized solar cells

In dye-sensitized solar cells (DSSCs) photogenerated positive charges are normally considered to be carried away from the dyes by a separate phase of hole-transporting material (HTM). We show that there can also be significant transport within the dye monolayer itself before the hole reaches the HTM. We quantify the fraction of dye regeneration in solid-state DSSCs that can be attributed to this process. By using cyclic voltammetry and transient anisotropy spectroscopy, we demonstrate that the rate of interdye hole transport is prevented both on micrometer and nanometer length scales by reducing the dye loading on the TiO₂ surface. The dye regeneration yield is quantified for films with high and low dye loadings (with and without hole percolation in the dye monolayer) infiltrated with varying levels of HTM. Interdye hole transport can account for >50% of the overall dye regeneration with low HTM pore filling. This is reduced to about 5% when the infiltration of the HTM in the pores is optimized in 2 μm thick films. Finally, we use hole transport in the dye monolayer to characterize the spatial distribution of the HTM phase in the pores of the dyed mesoporous TiO₂

Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): Rationale and design of a multicenter randomized clinical trial

Background: Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods: This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion: If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial registration:NCT02657044(Clinicaltrials.gov), registered January 8, 2016

Persistent dermatomal eruption on a leg

Unilateral linear capillaritis (ULC) is a rare variant of pigmented purpuric dermatoses (PPD) that is characterized by a linear or pseudo-dermatomal eruption on a single extremity. Although clinically distinct from the other PPD, it shares histopathologic features with this group. Herein, we present a man in his 50s who presented with asymptomatic macules and scaly papules on the left lower extremity in a linear distribution. The eruption persisted despite treatment with topical triamcinolone 0.1% and oral rutocide

Challenges and Opportunities for Developing Countries from Medical Tourism

Wikipedia defines “Medical Tourism” as the act of traveling to other countries to obtain medical, dental and surgical care. Rapid expansion of facilities for patients abroad has helped to spur this industry’s growth. Regardless of the destination, U.S. citizens are increasingly embracing the benefits of medical tourism due to dramatically rising U.S. healthcare costs. Medical care in countries such as India, Mexico, Thailand and Singapore can cost as little as ten percent of the cost of comparable care in the U.S. for some procedures. Statistical analysis revealed the costs to be significantly lower for many of these countries. Currently, patients from U.S., Canada, Europe, Australia and the Middle East appear to be traveling to destinations in Asia such as India and in Central America such as Mexico for medical care. Medical tourism can offer opportunities to developing countries to make improvements in their country and the host country can enjoy the economic benefit from medical tourism. However, there are also some challenges they may face from medical tourism. This paper discusses the opportunities and the challenges resulting from medical tourism for developing countries

Cancer risk and survival in path _ MMR carriers by gene and gender up to 75 years of age: a report from the prospective Lynch Syndrome database

Background Most patients with path_MMR gene variants (Lynch syndrome (LS)) now survive both their first and subsequent cancers, resulting in a growing number of older patients with LS for whom limited information exists with respect to cancer risk and survival. Objective and design This observational, international, multicentre study aimed to determine prospectively observed incidences of cancers and survival in path_MMR carriers up to 75 years of age. Results 3119 patients were followed for a total of 24 475 years. Cumulative incidences at 75 years (risks) for colorectal cancer were 46%, 43% and 15% in path_MLH1, path_MSH2 and path_MSH6 carriers; for endometrial cancer 43%, 57% and 46%; for ovarian cancer 10%, 17% and 13%; for upper gastrointestinal (gastric, duodenal, bile duct or pancreatic) cancers 21%, 10% and 7%; for urinary tract cancers 8%, 25% and 11%; for prostate cancer 17%, 32% and 18%; and for brain tumours 1%, 5% and 1%, respectively. Ovarian cancer occurred mainly premenopausally. By contrast, upper gastrointestinal, urinary tract and prostate cancers occurred predominantly at older ages. Overall 5-year survival for prostate cancer was 100%, urinary bladder 93%, ureter 85%, duodenum 67%, stomach 61%, bile duct 29%, brain 22% and pancreas 0%. Path_PMS2 carriers had lower risk for cancer. Conclusion Carriers of different path_MMR variants exhibit distinct patterns of cancer risk and survival as they age. Risk estimates for counselling and planning of surveillance and treatment should be tailored to each patient's age, gender and path_MMR variant. We have updated our open-access website www.lscarisk.org to facilitate this

Etiopathogenic features of acne vulgaris

Acne vulgaris is one of the most frequent dermatoses in the general population. Numerous scientific articles are available on acne, mostly relating to its etiopathogeny. This notwithstanding, the large amount of scientific information generated by works on acne vulgaris has made it difficult to converge knowledge on its etiopathogeny into a single understanding. Therefore, this review has been proposed to analyze the four classic mechanisms of this dermatosis (sebum production, follicular hyperkeratinization, bacterial colonization and glandular inflammation), as well as its secondary mechanism, namely hormonal mediation.A acne vulgar é uma das dermatoses mais freqüentes na população em geral. Encontra-se na literatura grande número de trabalhos científicos referentes sobretudo a sua etiopatogenia. No entanto, dado o grande número de informações geradas a respeito, dificilmente consegue-se reuni-las em entendimento comum. Esta revisão literária foi proposta a fim de abordar os mecanismos etiopatogênicos clássicos da acne vulgar (produção sebácea, hiperqueratinização folicular, colonização bacteriana folicular e inflamação glandular) e o mecanismo coadjuvante principal, a influência hormonal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Depto. de DermatologiaPontifícia Universidade Católica de Campinas Hospital e Maternidade Celso Pierro Serviço de DermatologiaUNIFESP, EPM, Depto. de DermatologiaSciEL