Pharmacy academics' perspectives toward interprofessional Education prior to its implementation in Qatar: a qualitative study

BACKGROUND: The aim of this study was to explore the perspectives of faculty members and academic administrators, at Qatar University College of Pharmacy, towards interprofessional education (IPE) and collaborative practice by identifying enablers, barriers and resources needed to implement IPE within the pharmacy curriculum. METHODS: A qualitative methodology was employed using focus groups discussions. Two focus groups were conducted, one focus group with faculty members (n?=?5) and another focus group with academic administrators (n?=?5) at Qatar University College of Pharmacy. Focus groups were audio recorded and transcribed verbatim by an independent experienced transcriber and validated by the study principal researcher. Thematic analysis was undertaken to generate key themes and subthemes. RESULTS: The study participants highlighted a number of enablers and challenges encountered as a result of the initial IPE events, for integrating IPE into the pharmacy curriculum. Many provided recommendations and suggestions for effective implementation of IPE. Analysis of the results focused on three main categories: enablers, barriers and recommendations. Overall, seven major themes were identified: 1) intrinsic enabling factors (initial IPE experiences, cross-appointed faculty, accreditation); 2) extrinsic enabling factors (national policy & legislation and advances in pharmacists' role); 3) student related benefits (roles & responsibilities and agents for change); 4) student hindering factors (student engagement, perceptions & attitudes and gender issues); 5) partnering academic institutions (logistical issues, familiarity with other curricula and commitment); 6) practice environment (hierarchy, healthcare professionals' attitude and lack of collaborative practice) and 7) IPE delivery (dedicated structure, IPE curriculum and extrinsic support). CONCLUSION: Pharmacy academics had positive perceptions towards IPE suggesting a high level of support and readiness to pursue IPE and an opportunity for pharmacy academics to drive the IPE agenda forward in Qatar. However, a number of challenges were reported. These are important to consider to ensure the development of effective strategies for the integration and enhancement of IPE and collaborative practice

Annular pancreas: endoscopic and pancreatographic findings from a tertiary referral ERCP center

Background and Aims Annular pancreas is a congenital anomaly whereby pancreatic tissue encircles the duodenum. Current knowledge of endoscopic findings of annular pancreas is limited to small case series. The aim of this study was to describe the endoscopic and pancreatographic findings of patients with annular pancreas at a large tertiary care ERCP center. Methods This is a retrospective observational study. Our Institutional Review Board–approved, prospectively collected ERCP database was queried for cases of annular pancreas. The electronic medical records were searched for patient and procedure-related data. Results From January 1, 1994, to December 31, 2016, 46 patients with annular pancreas underwent ERCP at our institution. Index ERCP was technically successful in 42 patients (91.3%), and technical success was achieved in all 46 patients (100%) after 2 attempts, when required. A duodenal narrowing or ring was found in most patients (n = 39, 84.8%), yet only 2 (4.3%) had retained gastric contents. Pancreas divisum was found in 21 patients (45.7%), 18 of which were complete divisum. Pancreatobiliary neoplasia was the indication for ERCP in 7 patients (15.2%). Pancreatographic findings consistent with chronic pancreatitis were noted in 15 patients (32.6%) at the index ERCP. Conclusion This is the largest series describing the endoscopic and pancreatographic findings of patients with annular pancreas. We found that 45.7% of patients had concurrent pancreas divisum. Endoscopic therapy was successful in most patients at our institution after 1 ERCP, and in all patients after a second ERCP. Nearly one-third of patients had findings consistent with chronic pancreatitis at the time of index ERCP. It is unclear whether this may be a feature of the natural history of annular pancreas

Crystal structure and chemistry of barium-graphite intercalation compounds

Graphite can accommodate various chemical species between graphene layers to form graphite intercalation compounds (GIC) [1]. Alkali metals can easily lead to bulk stage-1 intercalation compounds by vapor transport but for more electronegative elements, such as alkaline-earth metals or lanthanides, only a superficial intercalation is obtained and other synthesis methods have to be envisaged. Molten alloys, formed between an alkali metal and the targeted metal, have demonstrated their efficiency to prepare bulk and homogeneous GIC from these latter elements, for example the superconducting CaC6 phase [2], but some elements remain difficult to intercalate by this method. More recently, our team developed a method based on the work of Hagiwara et al., consisting in using a LiCl-KCl eutectic molten medium [3], which for example allowed to prepare for the first time a bulk SrC6 compound [4]. This work is focused on the intercalation of barium into graphite from the LiCl-KCl molten salts method. A bulk stage-1 BaC6 compound has been prepared and X-ray diffraction measurements confirmed its crystal structure [5]. Moreover, by varying the experimental conditions, two completely novel phases, denoted α and β, have been isolated. From ion beam analyses, Li0,2K0,6Ba0,35C6 and Li0,2K0,75Ba0,6C6 chemical formulae have been determined for α and β phases, respectively, showing that lithium and potassium are intercalated together with barium. X- ray diffraction led to the determination of the stacking sequence of each compound, and their planar unit cells. Lastly, a reaction mechanism is proposed, which explains the formation of the different phases observed in this study

Endoscopic retrieval of a proximally migrated biliary stent: digital cholangioscope to the rescue

Endoscopic techniques for the retrieval of proximally migrated biliary stents include the following: fluoroscopy-guided grasping of the stent with a rat-tooth forceps, balloon placement parallel to the stent with traction retrieval, cannulation of the stent lumen with a wire (standard technique, or use of the curved plastic tip of a modified Soehendra stent retriever [Cook Medical, Bloomington, Ind]) followed by use of standard or modified Soehendra stent retriever, wire-guided retrieval basket, and snare. The technique used depends on the extent of proximal stent migration, the presence of ductal dilatation or biliary stricture, and the endoscopist’s experience. This report describes the retrieval of a proximally migrated biliary stent within an aberrant right hepatic duct (RHD) using a digital cholangioscope (SpyGlass DS system; Boston Scientific, Natick, Mass

Autologous whole ram seminal plasma and its vesicle-free fraction improve motility characteristics and membrane status but not in vivo fertility of frozen-thawed ram spermatozoa

Motility characteristics (assessed subjectively and with computer-assisted semen analysis) and membrane status (after staining with chlortetracycline) of washed and non-washed frozen-thawed ram spermatozoa were evaluated after incubation in buffer and buffer containing autologous whole seminal plasma or one of its two fractions: the pellet of membrane vesicles obtained by ultracentrifugation (and used at three times normal protein concentration) or the vesicle-free supernatant fraction. Whole seminal plasma and supernatant, but not membrane vesicles, improved the motility characteristics of spermatozoa after 3 and 6 h of post-thaw incubation compared with the control buffer. Resuspension and incubation with whole seminal plasma, supernatant or membrane vesicles lowered the proportion of acrosome-reacted frozen-thawed spermatozoa compared with the control buffer. Unwashed frozen-thawed semen from three rams, incubated with autologous whole seminal plasma or its fractions and inseminated using cervical or intrauterine artificial insemination, had no effect on pregnancy rates of ewes in synchronized oestrus. However, fertility was higher after laparoscopic than cervical insemination (44.9 vs 12.3%, p < 0.001). In conclusion, resuspension and incubation of frozen-thawed ram spermatozoa in autologous whole seminal plasma or its vesicle-free supernatant fraction improved their motility characteristics and, with membrane vesicles, membrane status, but these benefits were not reflected in improved fertility after cervical or intrauterine insemination. © 2007 The Authors

Global existence for a system of non-linear and non-local transport equations describing the dynamics of dislocation densities

In this paper, we study the global in time existence problem for the Groma-Balogh model describing the dynamics of dislocation densities. This model is a two-dimensional model where the dislocation densities satisfy a system of transport equations such that the velocity vector field is the shear stress in the material, solving the equations of elasticity. This shear stress can be expressed as some Riesz transform of the dislocation densities. The main tool in the proof of this result is the existence of an entropy for this syste

Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis

Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5%) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75 %). Among these responders, 10 patients (83.3 %) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7 %) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail

Ethnic differences in calcium, phosphate and bone metabolism

The prevalence of osteoporosis and the incidence of age-related fragility fracture vary by ethnicity. There is greater than 10-fold variation in fracture probabilities between countries across the world. Mineral and bone metabolism are intimately interlinked, and both are known to exhibit patterns of daily variation, known as the diurnal rhythm (DR). Ethnic differences are described for Ca and P metabolism. The importance of these differences is described in detail between select ethnic groups, within the USA between African-Americans and White-Americans, between the Gambia and the UK and between China and the UK. Dietary Ca intake is higher in White-Americans compared with African-Americans, and is higher in White-British compared with Gambian and Chinese adults. Differences are observed also for plasma 25-hydroxy vitamin D, related to lifestyle differences, skin pigmentation and skin exposure to UVB-containing sunshine. Higher plasma 1,25-dihydroxy vitamin D and parathyroid hormone are observed in African-American compared with White-American adults. Plasma parathyroid hormone is also higher in Gambian adults and, in winter, in Chinese compared with White-British adults. There may be ethnic differences in the bone resorptive effects of parathyroid hormone, with a relative skeletal resistance to parathyroid hormone observed in some, but not all ethnic groups. Renal mineral excretion is also influenced by ethnicity; urinary Ca (uCa) and urinary P (uP) excretions are lower in African-Americans compared with White-Americans, and in Gambians compared with their White-British counterparts. Little is known about ethnic differences in the DR of Ca and P metabolism, but differences may be expected due to known differences in lifestyle factors, such as dietary intake and sleep/wake pattern. The ethnic-specific DR of Ca and P metabolism may influence the net balance of Ca and P conservation and bone remodelling. These ethnic differences in Ca, P and the bone metabolism may be important factors in the variation in skeletal health

Low Serum Pancreatic Amylase and Lipase Values Are Simple and Useful Predictors to Diagnose Chronic Pancreatitis

Background/Aims This study aimed to evaluate the diagnostic role of low serum amylase and lipase values in the detection of chronic pancreatitis. Methods Patients underwent endoscopic retrograde cholangiopancreatography and were diagnosed with non-calcific chronic pancreatitis (NCCP; n=99) and calcific chronic pancreatitis (CCP; n=112). Patient serum amylase and lipase values were compared with those of healthy controls (H; n=170). Results The median serum amylase (normal range, 19 to 86 U/L) and lipase values (7 to 59 U/L) (P25–P75) were 47.0 (39.8 to 55.3) and 25.0 (18.0 to 35.0) for H, 34.0 (24.5 to 49.0) and 19.0 (9.0 to 30.0) for NCCP, and 30.0 (20.0 to 40.8) and 10.0 (3.0 to 19.0) for CCP, respectively. The cutoff values with the highest diagnostic accuracy for discriminating NCCP from H were 40 U/L for amylase and 20 U/L for lipase, respectively, and for CCP from H were 38 U/L for amylase and 15 U/L for lipase, respectively. For the diagnosis of NCCP with a criterion of serum amylase <40 and lipase <20 U/L, the sensitivity, specificity, positive predictive value, and negative predictive values were 37.4%, 88.8%, 66.1%, and 70.9%, respectively. Conclusions Serum amylase and/or lipase levels below the normal serum range are highly specific for chronic pancreatitis patients. Clinicians should not ignore low serum pancreatic enzyme values

Additional flap on plastic stents for improved antimigration effect in the treatment of post-cholecystectomy bile leak

Background and study aims: In plastic stent insertion for treatment of post-cholecystectomy bile leak, stent migration may be more common due to the absence of a shelf to anchor the stent. We evaluated how adding a flap to straight plastic stents for this indication might influence the rate of stent migration when compared to use of conventional plastic stents. Patients and methods: This is a retrospective study including patients referred for ERCP for treatment of post-cholecystectomy bile leak. Patients with a customized anti-migration flap stent had the additional flap created on the distal end of straight plastic stents, intended to aid in anchoring in the distal supra-sphincteric biliary duct. The primary endpoint is stent migration events. The secondary endpoint is bile leak resolution after first ERCP session. Results: Thirty-two patients were treated with the experimental additional flap stents and 225 patients were treated with standard straight biliary stents. The total failure rate of bile leak resolution after a single endoscopic treatment for all treated was 10.5 % (27/257) and the total stent migration rate for all enrolled was 15.2 % (39/257). Stent migration rate was lower in the additional flap stent group than in the conventional group (3.1 % vs. 16.9 %, respectively, P  = 0.04). Furthermore, significantly more patients had resolution of their bile leak after the first ERCP session in the group with the additional flap (100 % vs. 88 %, respectively, P  = 0.03). Conclusion: A plastic biliary stent with an extra flap may have improved performance with regard to stent migration and resolution of bile leak over standard plastic biliary stents