Evaluating the impact of an interprofessional education simulation: A methodology

articleIn an effort to improve the quality of health care delivery, training health professional students to work effectively in interprofessional teams has become a high priority of many educational establishments, and the health professional community (Institute of Medicine, 2015; Association of Departments of Family Medicine, 2013). Giving students the opportunity to learn about and interact with students from other health professional programs is the purpose of interprofessional education (IPE), which is a required element of most foundational health professional curricula, including medicine, pharmacy, nursing, and others (Association of Departments of Family Medicine, 2013). IPE curriculum is not standardized across differen education settings and is delivered using a variety of methods. Assessing the impact of these IPE activities on learners' ability to work effectively in interprofessional teams is difficult due to the lack of established cost-effective assessment methods. Limited assessment tools has also contributed to difficulties in efforts to improve interprofessional education curriculum

Analiza studium przypadku choroby Parkinsona

Young onset Parkinson’s disease (YOPD) is defined as idiopathic Parkinson’s disease (IPPD) affecting people between the ages of 21 and 40 years old; it makes up approx. 5% of all Parkinson’s Disease patients. The quicker onset of motor complications is what makes YOPD different than the later onset of Parkinson’s Disease. The quicker onset of the motor complications and progression of the disease are what make this disease have a very high morbidity rate. Technology and research have provided the ability to improve motor complications dramatically and extend the ability to maintain function and live a meaningful life. Due to the specificity of the progression of YOPD, nurses and medical staff need to base the care and treatment of the patient on the patient rather than follow a standard protocol for everyone. The University of California in San Francisco (UCSF) symptom management theory and the theory implication for persons with neurological disorders/diseases can provide the basis on how to effectively develop a care plan for these patients. Nurses can have a significant impact on how the disease can affect the patient on the long-term through education, support and advocacy. This case history documents the course of a YOPD patient with unusually severe motor complications. This case study is presenting a 38-year-old male patient that has developed rhabdomyolysis due to dyskinesia. This article aims to help provide context and information pertaining to the usage of simulations when educating both undergraduate and graduate nursing students. (JNNN 2021;10(2):71–76)Choroba Parkinsona o początku w młodym wieku (YOPD) jest definiowana jako idiopatyczna choroba Parkinsona (IPPD) dotykająca ludzi w wieku od 21 do 40 lat; stanowi około 5% wszystkich pacjentów z chorobą Parkinsona. Szybszy początek powikłań ruchowych sprawia, że YOPD różni się od późniejszego wystąpienia choroby Parkinsona. Szybszy początek powikłań ruchowych i progresja choroby sprawiają, że schorzenie to ma bardzo wysoki wskaźnik zachorowalności. Technologia i badania pozwoliły radykalnie poprawić występujące komplikacje ruchowe i wydłużyć zdolność do zachowania funkcji i prowadzenia „sensownego” życia. Ze względu na specyfikę progresji YOPD pielęgniarki i personel medyczny musi dostosować opiekę i leczenie do danego pacjenta, a nie postępować zgodnie ze standardowym protokołem dla wszystkich. Teoria zarządzania objawami i implikacje teoretyczne dla osób z zaburzeniami/chorobami neurologicznymi Uniwersytetu Kalifornijskiego w San Francisco (UCSF) mogą stanowić podstawę skutecznego opracowania planu opieki dla tych pacjentów. Pielęgniarki mogą mieć znaczący wpływ na długofalowe oddziaływanie choroby na pacjenta poprzez edukację, wsparcie i poradnictwo. Przedstawiona historia przypadku dokumentuje przebieg pacjenta z YOPD z niezwykle ciężkimi powikłaniami ruchowymi. Niniejsze studium przypadku przedstawia 38-letniego mężczyznę, u którego rozwinęła się rabdomioliza z powodu dyskinezy. Celem tego artykułu jest przedstawienie kontekstu i informacji dotyczących wykorzystania symulacji podczas kształcenia zarówno studentów studiów licencjackich, jak i magisterskich z zakresu pielęgniarstwa. (PNN 2021;10(2):71–76

Rubric scoring of a clinical test of executive functioning

Executive functions (EF) are complex abilities that allow one to successfully complete independent, deliberate, and novel goal-directed activities (Lezak, Howieson, & Loring, 2004). EF tests require solving problems with minimal direction from the examiner (Baddeley, 1992; Shallice & Burgess, 1991). Because EF skills tend to show up globally, Lezak et al. (2004) suggested clinicians will learn more about one’s EF abilities by observing how he or she goes about solving a problem than from a test score. If this is the case, a “rubric” score that took into consideration “how” a problem was solved may provide the clinician with better information for treatment planning than a test score, as long as it did not greatly affect test sensitivity or specificity. Sensitivity and specificity are important factors in determining the usefulness of EF tests. Sensitivity refers to the probability of identifying abnormal functioning in an impaired individual or “hit rate” of a test, whereas specificity reflects the probability of correctly identifying healthy individual with the test (Cartoni & Lincoln, 2005; Kiel & Kaszniak, 2002). Rubrics are useful scoring tools that divide tasks into component elements and provide a description of levels of performance for each element (Goodrich, 2005; Hanna & Smith, 1998). Rubrics have been widely used to assess student performance (Andrade, 2000; Falchikov, 1986; Goodrich, 1997), but have not been used to score EF tests. The aim of this study was to examine sensitivity and specificity for a clinical test of EF, the Rapid Assessment of Problem Solving test (RAPS) when scored with a rubric that allowed the examiner to describe the quality of performance using a standard that was developed from a large body of normative research. This differs from using the three traditional test scores from the RAPS that require time intensive calculations

Problem Solving by Participants with and without Neurological Damage on the Rapid Assessment of Problem Solving Test

This study examined problem solving by participants with and without neurologic damage on a modification of the Rapid Assessment of Problem Solving Test (RAPS). Results revealed significant differences among the groups on four measures of problem-solving efficiency as well as the types of questions used to solve problems on the RAPS. Participants in acute TBI and Schizophrenia groups performed significantly poorer than those in a chronic TBI group, and two groups of non-brain-damaged individuals. Examination of the problem-solving strategies used by the groups showed that neurologically damaged participants used similar strategies to the normal participants, but deteriorated in their performance as the complexity of the problem solving task increased

Reliability and validity of the Wolfram Unified Rating Scale (WURS)

BACKGROUND: Wolfram syndrome (WFS) is a rare, neurodegenerative disease that typically presents with childhood onset insulin dependent diabetes mellitus, followed by optic atrophy, diabetes insipidus, deafness, and neurological and psychiatric dysfunction. There is no cure for the disease, but recent advances in research have improved understanding of the disease course. Measuring disease severity and progression with reliable and validated tools is a prerequisite for clinical trials of any new intervention for neurodegenerative conditions. To this end, we developed the Wolfram Unified Rating Scale (WURS) to measure the severity and individual variability of WFS symptoms. The aim of this study is to develop and test the reliability and validity of the Wolfram Unified Rating Scale (WURS). METHODS: A rating scale of disease severity in WFS was developed by modifying a standardized assessment for another neurodegenerative condition (Batten disease). WFS experts scored the representativeness of WURS items for the disease. The WURS was administered to 13 individuals with WFS (6-25 years of age). Motor, balance, mood and quality of life were also evaluated with standard instruments. Inter-rater reliability, internal consistency reliability, concurrent, predictive and content validity of the WURS were calculated. RESULTS: The WURS had high inter-rater reliability (ICCs>.93), moderate to high internal consistency reliability (Cronbach’s α = 0.78-0.91) and demonstrated good concurrent and predictive validity. There were significant correlations between the WURS Physical Assessment and motor and balance tests (r(s)>.67, p<.03), between the WURS Behavioral Scale and reports of mood and behavior (r(s)>.76, p<.04) and between WURS Total scores and quality of life (r(s)=-.86, p=.001). The WURS demonstrated acceptable content validity (Scale-Content Validity Index=0.83). CONCLUSIONS: These preliminary findings demonstrate that the WURS has acceptable reliability and validity and captures individual differences in disease severity in children and young adults with WFS

Diagnostic and clinical experience of patients with pantothenate kinase-associated neurodegeneration

BACKGROUND: Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive neurodegenerative disorder with brain iron accumulation (NBIA). OBJECTIVES: To assess PKAN diagnostic pathway, history, and burden across the spectrum of PKAN severity from patient and/or caregiver perspectives. METHODS: Caregivers of patients (n = 37) and patients themselves (n = 2) were interviewed in a validation study of the PKAN-Activities of Daily Living (ADL) scale. The current study used quartiles of the PKAN-ADL total score to divide patients by severity of impairment (Lowest, Second Lowest, Third Lowest, Highest). Diagnostic and treatment history, healthcare utilization, disease burden, and caregiver experience were compared between groups. RESULTS: The analyses included data from 39 patients. Mean age at PKAN symptom onset (P = 0.0007), initial MRI (P = 0.0150), and genetic testing (P = 0.0016) generally decreased across the PKAN severity spectrum. The mean duration of illness did not differ among PKAN severity groups (range, 9.7-15.2 years; P = 0.3029). First MRI led to diagnosis in 56.4% of patients (range, 30.0-90.0%). A mean (SD) of 13.0 (13.1) medical and 55.2 (78.5) therapy visits (eg, physical, speech) occurred in the past year. More patients in the higher PKAN severity groups experienced multiple current functional losses and/or earlier onset of problems (P-values \u3c 0.0500). Over half (56.8%) of caregivers experienced a change in employment because of caregiving. The percentage of patients requiring full-time caregiving increased across the PKAN severity spectrum (range, 11.1-100%; P = 0.0021). CONCLUSIONS: PKAN diagnosis was often delayed, most probably due to low awareness. Considerable burden of functional impairment and high healthcare utilization were found across the PKAN severity spectrum

Ebola Virus Persistence in Semen of Male Survivors

We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and 70 days, respectively, after EVD onset

Heterogeneity of Purkinje cell simple spike-complex spike interactions:zebrin- and non-zebrin-related variations

KEY POINTS: Cerebellar Purkinje cells (PCs) generate two types of action potentials, simple and complex spikes. Although they are generated by distinct mechanisms, interactions between the two spike types exist. Zebrin staining produces alternating positive and negative stripes of PCs across most of the cerebellar cortex. Thus, here we compared simple spike-complex spike interactions both within and across zebrin populations. Simple spike activity undergoes a complex modulation preceding and following a complex spike. The amplitudes of the pre- and post-complex spike modulation phases were correlated across PCs. On average, the modulation was larger for PCs in zebrin positive regions. Correlations between aspects of the complex spike waveform and simple spike activity were found, some of which varied between zebrin positive and negative PCs. The implications of the results are discussed with regard to hypotheses that complex spikes are triggered by rises in simple spike activity for either motor learning or homeostatic functions. ABSTRACT: Purkinje cells (PCs) generate two types of action potentials, called simple and complex spikes (SSs and CSs). We first investigated the CS-associated modulation of SS activity and its relationship to the zebrin status of the PC. The modulation pattern consisted of a pre-CS rise in SS activity, and then, following the CS, a pause, a rebound, and finally a late inhibition of SS activity for both zebrin positive (Z+) and negative (Z-) cells, though the amplitudes of the phases were larger in Z+ cells. Moreover, the amplitudes of the pre-CS rise with the late inhibitory phase of the modulation were correlated across PCs. In contrast, correlations between modulation phases across CSs of individual PCs were generally weak. Next, the relationship between CS spikelets and SS activity was investigated. The number of spikelets/CS correlated with the average SS firing rate only for Z+ cells. In contrast, correlations across CSs between spikelet numbers and the amplitudes of the SS modulation phases were generally weak. Division of spikelets into likely axonally propagated and non-propagated groups (based on their interspikelet interval) showed that the correlation of spikelet number with SS firing rate primarily reflected a relationship with non-propagated spikelets. In sum, the results show both zebrin-related and non-zebrin-related physiological heterogeneity in SS-CS interactions among PCs, which suggests that the cerebellar cortex is more functionally diverse than is assumed by standard theories of cerebellar function

Fermi Large Area Telescope Constraints on the Gamma-ray Opacity of the Universe

The Extragalactic Background Light (EBL) includes photons with wavelengths from ultraviolet to infrared, which are effective at attenuating gamma rays with energy above ~10 GeV during propagation from sources at cosmological distances. This results in a redshift- and energy-dependent attenuation of the gamma-ray flux of extragalactic sources such as blazars and Gamma-Ray Bursts (GRBs). The Large Area Telescope onboard Fermi detects a sample of gamma-ray blazars with redshift up to z~3, and GRBs with redshift up to z~4.3. Using photons above 10 GeV collected by Fermi over more than one year of observations for these sources, we investigate the effect of gamma-ray flux attenuation by the EBL. We place upper limits on the gamma-ray opacity of the Universe at various energies and redshifts, and compare this with predictions from well-known EBL models. We find that an EBL intensity in the optical-ultraviolet wavelengths as great as predicted by the "baseline" model of Stecker et al. (2006) can be ruled out with high confidence.Comment: 42 pages, 12 figures, accepted version (24 Aug.2010) for publication in ApJ; Contact authors: A. Bouvier, A. Chen, S. Raino, S. Razzaque, A. Reimer, L.C. Reye

Persistence of Ebola virus in ocular fluid during convalescence

Please note: A correction to the original article has been published. “From New England Journal of Medicine, Jay B. Varkey, Jessica G. Shantha, Ian Crozier, Colleen S. Kraft, G. Marshall Lyon, Aneesh K. Mehta, Gokul Kumar, Justine R. Smith, Markus H. Kainulainen, Shannon Whitmer, Ute Ströher, Timothy M. Uyeki, Bruce S. Ribner, and Steven Yeh, Persistence of Ebola Virus in Ocular Fluid during Convalescence, 2015; 372:2423-2427. Copyright © (2015) Massachusetts Medical Society. Reprinted with permission.Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.Supported by a grant from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000454, to the Atlanta Clinical and Translational Science Institute), an unrestricted grant from Research to Prevent Blindness and a grant from the National Eye Institute (P30-EY06360, to the Department of Ophthalmology, Emory University School of Medicine), and a fellowship grant from the Australian Research Council (FT130101648, to Dr. Smith). Favipiravir was provided by the Department of Defense Joint Project Manager Medical Countermeasure Systems