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

Endothelial Injury in Scleroderma

Scleroderma, which follows rheumatoid arthritis and systemic lupus erythematosus as the third most prevalent rheumatic disorder, is poorly understood. Connective tissue abnormalities have been explored extensively (1); recently, vascular involvement has been emphasized as a unifying pathogenetic concept (2, 3). The vascular features in scleroderma include Raynaud\u27s phenomenon; an early, edematous phase of the disorder; telangiectasia; capillary abnormalities as seen by nailfold and ultrastructural microscopy; and widespread vascular pathology noted in all involved organs. The most striking histological abnormalities occur in small arteries and arterioles and consist of distinctive intimal proliferation of cells arranged concentrically in a matrix of ground substance; the cells are thought to originate from medial smooth muscle and to migrate toward the intima after injury to the endothelium (4). Evidence for endothelial injury includes: (a) the disappearance of endothelium in association with thrombosis or fibrinoid necrosis in ultrastructural studies; (b) the absence of endothelial cells within the thickened intima (4, 3) the duplication of basement membrane, a common observation in scleroderma and known to occur after endothelial perturbation in other settings. The ability to isolate, characterize, and maintain endothelial cells in vitro provides a target-cell population to study endothelial damage in scleroderma. The present report describes the effect of scleroderma serum on endothelial, smooth muscle, and fibroblast cell types. Sera from patients with scleroderma (31/52) and Raynaud\u27s syndrome (11/19) contain cytotoxic activity specific for endothelial cells which is nondialyzable, heat-stable, and elutes with albumin on gel-filtration chromatography

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

A Review on the Use of Confocal Laser Endomicroscopy in the Bile Duct

Background. Current methods to diagnose malignant biliary strictures are of low sensitivity. Probe-based confocal laser endomicroscopy (pCLE) is a new approach that can be used to evaluate in vivo histopathology of the GI tract. This paper is of studies evidencing pCLE's application in the diagnosis of indeterminate biliary strictures. Methods. This paper examined peer-reviewed studies conducted between January 2000 and November 2011. A PubMed search for relevant articles was performed using the following keywords:“pCLE”, “confocal”, “endomicroscopy”, “probe-based confocal laser endomicroscopy”, “and “bile duct”. Further individual review was done to assess the screened articles' relevance to the topic. Results. After individual review, 6 studies were included; with a cumulative sample size of 165, with 75 subjects identified as having a malignancy. These studies included tertiary care centers in Germany, France, and USA, including one multicenter trial. 3 studies assessed pCLE's specificity (range 67%–88%) ,sensitivity (range 83%–98), and accuracy (range 81%–86%). Conclusion. Confocal endomicroscopy is a novel and promising modality for the biliary tree. Further studies need to be conducted both to establish its usefulness for the diagnosis of indeterminate biliary strictures and to understand the histological meaning of the imaging patterns that are observed

Downregulation of Microrna-126 in Scleroderma is Associated with Epigenetically Mediated Nitric Oxide Synthase Repression and Enhanced Platelet/Endothelial Interaction

Please view the PDF to see the formatted meeting abstract

ANCA in systemic sclerosis, when vasculitis overlaps with vasculopathy: a devastating combination of pathologies

In patients with systemic sclerosis (SSc), the coexistence of ANCA-associated vasculitis (SSc-AAV) has been reported to be associated with a severe disease course, including significant pulmonary and renal involvement. The presence of ANCA is not uncommon in patients with SSc and therefore clinicians must maintain a high index of clinical suspicion about SSc-AAV. p-ANCA and anti-MPO antibodies are the most common antibodies observed. Patients typically present with clinical features of microscopic polyangiitis or renal-limited vasculitis There are multiple areas of potential interaction in the pathogenesis of SSc and AAV which can exacerbate/compound vascular disease. In addition, similar patterns of major internal organ involvement (e.g., lung and kidneys) are seen in both conditions. We highlight a diagnostic approach to SSc-AAV and the paucity of data to inform management. As such, SSc-AAV is typically treated as per isolated AAV which can potentially be hazardous in patients with SSc (e.g., the association between high-dose steroid and scleroderma renal crisis). We propose that this rare clinical entity warrants rigorous investigation including definition of a therapeutic strategy to ameliorate the potentially devastating combination of pathologies in SSc-AAV

Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation

Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply, but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation

The role of the dermatologist in Raynaud’s phenomenon: a clinical challenge

Raynaud’s phenomenon (RP) is a functional vascular disorder involving extremities. In his practice, the dermatologist may frequently encounter RP which affects mainly women and is categorized into a primary benign form and a secondary form associated with different diseases (infections, drugs, autoimmune and vascular conditions, haematologic, rheumatologic and endocrinologic disorders). Still today, the differential diagnosis is a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy, is mandatory. RP is generally benign, but a scheduled followâ up for primary RP patients should be established, due to risk of evolution to secondary RP. A combination of conservative measures and medications can help in the management of RP. The importance of avoiding all potential physical, chemical and emotional triggers, as well as quitting smoking, should be strongly suggested to the patient. As firstâ line treatment, dihydropyridine calcium channel blockers should be used. If this approach is not sufficient, prostacyclin derivatives, phosphodiesterases inhibitors and endothelin receptor antagonists can be considered as secondâ line treatment. In cases of acute ischaemia, nifedipine and intravenous prostanoids are helpful. In refractory cases, botulinum injections have shown a significant benefit. The approach to the RP patients requires therefore a coordinated care of specialists together with the primary care physician.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144681/1/jdv14914_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144681/2/jdv14914.pd

Decreased Prevalence of Autoimmune Connective Tissue Diseases in Type 1 and Type 2 Diabetes

Please view the PDF To see the formatted meeting abstract