Impact of an Interprofessional Leadership Program on Collaboration in Practice

Purpose The purpose of this project was to improve attitudes towards collaboration between nurse and physician leaders and to describe the changes in attitudes and behaviors following completion of an interprofessional education (IPE) leadership development program. Significance The Institute of Medicine (IOM) 1999 study, To Err is Human: Building a Safer Health System, demonstrated that poor collaboration among clinicians can contribute to negative patient outcomes and further outlined that traditional methods of learning in healthcare result in nurses and physicians becoming isolated from one another and thus unprepared to work collaboratively (Delunas & Rouse, 2014). The nurse-physician (RN-MD) relationship is complex and is influenced by differences in both methods of academic preparation and the perceived value and definition of collaboration between the two groups (Hughes and Fitzpatrick, 2010). Unhealthy relationships such as those that are hostile or disruptive can result in lower levels of job satisfaction, retention, and safety and quality of care delivery (Rosenstein & O’Daniel, 2005; Manojlovich & DeCicco, 2007). The collaborative relationship includes mutual trust, open communication and respect for the skills of each discipline (Schmalenberg, et al., 2005). For true collaborative relationships to develop, each professional must value the other discipline’s contribution, creating mutual or equal power in their relationship (Nelson, King, & Brodine, 2008). This requires confronting the perception that each party has of the other’s role. The theoretical framework that supports this process is Critical Social Theory (Freire 1972 as cited in Fulton, 1997), which promotes social phenomenon as being explained by evaluating the history of the social development. The theory framework is dependent on the assumption that knowledge of the current state will facilitate change in the relationship. Utilizing social theory allows for the application of praxis, or reflection with action. Praxis is the first step towards empowerment to change. Identifying the attitudes towards collaboration will provide objective data on the true state of perceptions and provide for reflection with actions that facilitate the RN-MD empowerment to change their relationship

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence