Interprofessional education in a student-led emergency department : a realist evaluation

This paper reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations and questionnaires to study what worked, for whom and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing and physiotherapy students, their supervisors and two members of the emergency department’s management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team

Women’s experiences of wearing therapeutic footwear in three European countries

Background: Therapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women’s experiences of the process of being provided with it and wearing it. No previous work has compared women’s experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain. Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data. Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approach to the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women’s wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear. Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an ‘intervention’. The participant’s experience of their consultations with practitioners has revealed the tension between the practitioners’ requirements and the women’s ‘social’ needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention

Developmental programming of cardiovascular dysfunction by prenatal hypoxia and oxidative stress.

Fetal hypoxia is a common complication of pregnancy. It has been shown to programme cardiac and endothelial dysfunction in the offspring in adult life. However, the mechanisms via which this occurs remain elusive, precluding the identification of potential therapy. Using an integrative approach at the isolated organ, cellular and molecular levels, we tested the hypothesis that oxidative stress in the fetal heart and vasculature underlies the molecular basis via which prenatal hypoxia programmes cardiovascular dysfunction in later life. In a longitudinal study, the effects of maternal treatment of hypoxic (13% O(2)) pregnancy with an antioxidant on the cardiovascular system of the offspring at the end of gestation and at adulthood were studied. On day 6 of pregnancy, rats (n = 20 per group) were exposed to normoxia or hypoxia ± vitamin C. At gestational day 20, tissues were collected from 1 male fetus per litter per group (n = 10). The remaining 10 litters per group were allowed to deliver. At 4 months, tissues from 1 male adult offspring per litter per group were either perfusion fixed, frozen, or dissected for isolated organ preparations. In the fetus, hypoxic pregnancy promoted aortic thickening with enhanced nitrotyrosine staining and an increase in cardiac HSP70 expression. By adulthood, offspring of hypoxic pregnancy had markedly impaired NO-dependent relaxation in femoral resistance arteries, and increased myocardial contractility with sympathetic dominance. Maternal vitamin C prevented these effects in fetal and adult offspring of hypoxic pregnancy. The data offer insight to mechanism and thereby possible targets for intervention against developmental origins of cardiac and peripheral vascular dysfunction in offspring of risky pregnancy

Immune signatures and disorder-specific patterns in a cross-disorder gene expression analysis

BACKGROUND: Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology. AIMS: To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD). METHOD: Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD-ASD (n = 16) and healthy controls (n = 78). RESULTS: Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures. CONCLUSIONS: Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors

Effects of the 5-HT2C receptor agonist meta-chlorophenylpiperazine on appetite, food intake and emotional processing in healthy volunteers

RATIONALE: The treatment of obesity is an increasing global health priority, yet few effective drug treatments are currently available. The discovery of novel anti-obesity therapies could be assisted by the validation of experimental (translational) medicine models in healthy volunteers that assess efficacy and safety at an early stage of drug development. OBJECTIVES: The aim of this study was to examine the effects of the 5-HT2C receptor agonist meta-chlorophenylpiperazine (mCPP) in an experimental medicine model assessing both appetite and mood. METHODS: Using a between-subjects, double-blind, placebo-controlled design, 24 male and 24 female participants were randomly assigned to either placebo, 15- or 30-mg mCPP treatment groups. Lunch was eaten from a Universal Eating Monitor (UEM) that measured eating rate, and the participants completed the P1vital® Oxford Emotional Test Battery (ETB) and a series of appetite and mood ratings. RESULTS: mCPP reduced appetite and, in women, enhanced measures of satiation. The drug also enhanced memory for emotional material in the word recall and recognition memory tasks of the ETB. CONCLUSIONS: The results provide new insight into the effects of mCPP on appetite, satiety and memory in humans. In addition, our data provide an illustration of the value of measuring changes in appetite and mood in healthy volunteers to determine the potential efficacy and safety of novel anti-obesity drugs

Tail biting in pigs: a multi-causal behavioural disorder

Grizenje repova poremećaj je ponašanja svinja, multikauzalne prirode, a smatra se da motivacija za grizenje proizlazi iz nemogućnosti izražavanja vrsti specifičnog ponašanja (rovanje ili žvakanje). Stoga, životinje preusmjeravaju svoje ponašanje na druge objekte koji su im na raspolaganju, kao što su primjerice uške ili repovi drugih životinja. Grizenje repova izrazito je raširena pojava u uzgoju svinja koja stvara velike ekonomske gubitke i utječe na dobrobit životinja. Ovaj poremećaj ponašanja svinja ima najmanje tri različita polazišta na osnovi kojih se dijeli na tri osnovna oblika. Prvi je oblik ‘dvofazno ili dvo-stupanjsko grizenje’, a kako mu i samo ime govori, sastoji se od dvije odvojene faze. U prvoj fazi svinja nježno drži rep druge u ustima bez da izazove bilo kakvo vidljivo oštećenje tkiva. Tada proces prelazi u drugu fazu, pri čemu ozljeda na repu i posljedično krvarenje privlači i druge životinje iz skupine te naglo dolazi da eskalacije poremećaja ponašanja. Drugi oblik naziva se ‘iznenadno-snažno grizenje’, i kod njega dolazi do naglog i snažnog napada jedne svinje na rep druge svinje. Kod ovog oblika poremećaja odmah dolazi do većih ozljeda, s mogućim djelomičnim ili potpunim gubitkom repa te se ovaj oblik grizenja vrlo često determinira kao kanibalizam. Treći se oblik ovog poremećaja u ponašanju naziva „opsesivno grizenje“. On podrazumijeva snažno i stalno grizenje repova od strane jedne ili nekoliko životinja u skupini. Životinje koje pokazuju ovaj oblik ponašanja stalno su u potrazi za žrtvom te iz tog razloga ovaj oblik grizenja rezultira vrlo brzo do većeg broja ozljeda. Kao mogući uzroci ovog poremećaja spominju se zdravstveno stanje, neodgovarajući uvjeti držanja i nedostatna, odnosno nepravilna hranidba, a kao ne manje važni čimbenici spominju se spol, stres, dosada i genetska predispozicija. Usporedba podataka iz različitih do sad provedenih istraživanja otežana je zbog neujednačene terminologije i različitih načina definiranja ovog poremećaja ponašanja. Ovaj pregledni rad predstavlja aktualni pregled literaturnih saznanja o grizenju repova u svinja, i razmatra različite čimbenike okoliša i uzgoja koji mogu utjecati na njegovo izražavanje i složenost.Tail biting is a multi-causal behavioural disorder in pigs. It is considered that the motivation behind it comes from the pig’s inability to express its species-specific behaviour, such as rooting or chewing. Therefore, animals redirect their behaviour onto other objects available to them, such as the ears or tails of other animals. Tail biting is a widespread phenomenon in breeding pigs, causing great economic losses and affecting the welfare of animals. This behavioural disorder has at least three different starting points, based on which it can be divided into three basic forms. The first is called ‘two-stage biting’, where in the first stage the pig gently holds the tail in the mouth and manipulates it without causing any visible tissue damage. This process proceeds to the second stage, where tail injury and consequent bleeding attracts other animals from the group, when the disorder suddenly escalates. The second form is called ‘sudden-strong biting’, and it is manifested as a sudden and strong attack of one pig against the tail of another. This form of the disorder results in immediate injuries, with possible partial or complete loss of the tail. This form of biting is often determined as cannibalism. The third form of this behavioural disorder is called ‘obsessive biting’. It implies strong and consistent biting of tails by one or several animals in the group. Animals that show this form of behaviour are constantly in search of a victim, and for this reason, this form of tail biting quickly results in a great number of injuries. Possible causes for the development of this disorder include a range of factors, such as health status, inadequate housing, boredom, gender, stress, genetics and insufficient or improper nutrition, as outlined in the literature. Comparison of data from different studies has been hampered by the lack of uniform terminology and the many different definitions of this disorder. This review presents the current findings on the tail-biting phenomena in pigs, and consider the various factors of the environment and husbandry that can affect its expression and complexity

Effect of cimetidine, ranitidine, famotidine and omeprazole on hepatocyte proliferation in vitro

Recently reports have indicated that both cimetidine and ranitidine delay cell proliferation in rats following 70% partial hepatectomy and result in an increased mortality following this procedure. The present study was designed to determine whether three H2 blocking agents (cimetidine, ranitidine, famotidine) and a new, powerful antisecretory drug (omeprazole) specifically influence hepatocyte proliferation in primary culture. Hepatocytes were isolated from livers of normal male rats by the standard collagenase perfusion technique. Hepatic DNA synthesis and percent of labelled nuclei were determined after 48 h incubation. Hepatocytes in culture were incubated with the H2 blocking agents and omeprazole or with different concentrations of serum obtained from shamoperated or 70% hepatectomized rats treated or not with the same agents. Rats were injected intraperitoneally at 8:00 a.m. on two consecutive days. In hepatectomized rats, the first dose was injected at 8:00 a.m. immediately after surgery, the second, 24 h later. The serum of sham-operated or 70% hepatectomized rats that did not receive drugs served as control. No changes in DNA synthesis, percentage of labelled nuclei and transaminase were detected when the agents were added to the hepatocytes in culture at concentrations within the effective pharmacological dosage and 30 times higher. Similarly, no changes in these parameters were obtained when different concentrations of serum obtained from sham-operated rats treated with H2 blocking agents or omeprazole were added to the basal culture medium. However, a significant inhibition of DNA synthesis and of percentage of labelled nuclei was observed when hepatocytes were incubated in the presence of serum from 70% hepatectomized rats that had been treated with cimetidine or with ranitidine. The serum of 70% hepatectomized rats treated with famotidine and omeprazole had no effect on hepatocyte proliferation in vitro. No effect on transaminase was found in these conditions. © 1989

Consistent superiority of selective serotonin reuptake inhibitors over placebo in reducing depressed mood in patients with major depression.

The recent questioning of the antidepressant effect of selective serotonin reuptake inhibitors (SSRIs) is partly based on the observation that approximately half of company-sponsored trials have failed to reveal a significant difference between active drug and placebo. Most of these have applied the Hamilton depression rating scale to assess symptom severity, the sum score for its 17 items (HDRS-17-sum) serving as effect parameter. In this study, we examined whether the negative outcomes of many SSRI trials may be partly caused by the use of this frequently questioned measure of response. We undertook patient-level post-hoc analyses of 18 industry-sponsored placebo-controlled trials regarding paroxetine, citalopram, sertraline or fluoxetine, and including in total 6669 adults with major depression, the aim being to assess what the outcome would have been if the single item depressed mood (rated 0-4) had been used as a measure of efficacy. In total, 32 drug-placebo comparisons were reassessed. While 18 out of 32 comparisons (56%) failed to separate active drug from placebo at week 6 with respect to reduction in HDRS-17-sum, only 3 out of 32 comparisons (9%) were negative when depressed mood was used as an effect parameter (