Infusing the Interdisciplinary into Medical/ Health Sciences Education: Vitamins or Vaccines?

Academic medical institutions have responded to recent changes and challenges confronting the health care system with various recommendations for curricular reform; many grouped under the rubric of interdisciplinary training. The ultimate goal is to create physicians, with mastery over specialized knowledge, who can practice cost-effective, humanized medicine. This article elaborates a conceptual classification system that categorizes curricular reform recommendations into one of two approaches – Vitamins or Vaccines – that highlights differences in the processes of curricular reform programs. Programs seeking the same goal may create different types of practitioners depending on the approach dominating the professional training and socialization process. The Vitamins approach is reactive, supplemental, and incremental, often imparting instruction instead of education. The Vaccines approach is proactive, addresses fundamental factors, and seeks long-term solutions from a preventive perspective. As educators, our choice of approach, Vitamins or Vaccines, for curricular reform will determine how academia prepares physicians for the futur

Needs Assessment in Postgraduate Medical Education:A Review

Although the concept of needs assessment in continuing medical education is well accepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs assessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical education

Consolidation of P2Y12 Testing While Maintaining Quality and Turnaround Time

Objective: To consolidate the test performed at 2 different locations at 1, thereby improving cost effectiveness while maintaining quality and result turnaround time.https://jdc.jefferson.edu/patientsafetyposters/1059/thumbnail.jp

Lipid Metabolism

Perilipin 2, also known as Adipose differentiation-relation protein or PLIN2, is a lipid droplet-binding protein present in almost every tissue. The absence of PLIN2 upregulates hepatic very low-density lipoprotein secretion, relieves hepatosteatosis, and improves whole body insulin resistance in mice. Despite of the importance in mediating lipid metabolism, the regulation of PLIN2 itself remains largely unknown. Previous reports have shown that X-box binding protein 1 (XBP1) is an important regulator of lipogenesis. XBP1 is a transcription factor that recognizes and binds to a consensus sequence, 5’-TGACGTGG-3’. Interestingly, when we looked through the promoter region of mouse Plin2 gene, we found that the consensus sequence is present in the Plin2 promoter. Therefore, we hypothesize that XBP1 might directly bind to Plin2 promoter and regulate the Plin2 expression. To test our hypothesis, we will perform the luciferase assay to examine whether the Plin2 promoter activity is regulated by XBP1. We first designed forward and reverse PCR primers, which include BglII and BamHI restriction enzyme sites respectively, to amplify the Plin2 promoter region (from -1100 to +40). We performed PCR and cloned the Plin2 promoter to a TA vector. The TA vector was then sequenced to exclude any point mutations. After sequencing, we sub cloned the Plin2 promoter into a vector containing a luciferase reporter. In the future, we will transfect 293T, a human embryonic kidney cell line, with the Plin2 promoter-luciferase vector we generated. We will compare the Plin2 promoter activity by measuring the luminescence in the presence or absence of XBP1

The Role of School Health Education in the Promotion of Community Health

Tulisan ini merupakan uraian singkat mengenai peranan pendidikan kesehatan di sekolah dalam meningkatkan kesehatan masyarakat. Sesungguhnya tanggung jawab utama dalam mengajarkan perihal hidup sehat kepada anak-anak adalah para orang tua. Tetapi diakui bahwa pada saat ini umumnya perilaku sehat di masyarakat sebagai orang tua masih memprihatinkan. Banyak penyakit yang timbulakibat hidup tidak sesuai dengan norma kesehatan, Oleh karena itu diharapkan peran guru sebagai pengganti untuk mengajarkan dan menumbuhkan perilaku dan kebiasaan hidup sehat tersebut. Ada tiga hal utama yang ditekankan dalam program pendidikan kesehatan sekolah yaitu : 1) . Peningkatan pemahaman, sikap dan praktek hidup untuk mencapai derajat kesehatan tertinggi baik perorangan,ketuarga maupun masyarakat. 2). Pelayanan kesehatan yang meliputi kegiatan yang bertujuan untuk melindungi dan meningkatkan kesehatan. 3). Kesehatan lingkungan sekolah yang meliputi perencanaan, prosedur, fasilitas dan perlengkapan yang dapat meningkatkan kesehatan baik fisik maupun emosional

What Are Normal Cortisol Values for Young Children?

Normative ranges for cortisol levels in children remain controversial, because of diurnal variations, effects of age, sex, stressful experiences before sampling (blood, saliva), intercurrent illnesses/immunizations, sample preparation and analytical methods. Measuring hair cortisol concentrations (HCC) is unaffected by diurnal variations or many of these factors, and presents a summative measure of chronic stress. Depending on hair growth rates, approximately 1 cm of hair represents cortisol release over the past month. HCC does not fluctuate frequently and therefore represents cumulative stress over time. It is vitally important to establish normative cortisol levels in children, so that both maladaptive and toxic stress levels can be measured. Pilot data from children in the CANDLE Study (Conditions Affecting Neurocognitive Development & Learning in Early childhood) were analyzed to identify the 25th, 50th and 75th percentiles for HCC in 1-4 year-old children. Significantly higher HCC were noted in black vs. white children at 1, 2, 3, and 4-years (P\u3c0.001, for all ages). When measuring HCC we must also study the biochemical composition of an individual’s hair, primarily its lipid content. This lipid content is significantly different depending on one’s racial background and may account for some of the observed racial differences in HCC (Robbins, 2012). Establishing age-, sex-, and race-specific normative levels for HCC are essential for investigating the cumulative effects of chronic stress or “allostatic load” across the lifespan. If the normative ranges for HCC can be established, both the causes and effects of maladaptive and toxic stress can be subsequently identified, prevented and/or treated

Primary Care Patient Experience in Pneumonia Patient and the Effects of Readmissions

Patient primary care experience is an essential component of patient care. Research has consistently demonstrated that patient experience correlates with clinical processes of care for prevention and disease management and with better health outcomes. Patients who are admitted to the hospital face numerous challenges upon discharge, including high readmission rates. In fact, one-fifth of Medicare patients admitted to the hospital will be readmitted within 30 days of discharge. With the Affordable Care Act’s creation of the Hospital Readmission Reduction Program (HRRP), hospitals are now penalized for excess readmission rates for common admitting diagnoses such as pneumonia. The purpose of this study was to examine how patients’ baseline primary care experiences relate to the likelihood of readmission. Patients diagnosed with pneumonia were identified during their initial hospitalization and administered the CG-CAHPS 3.0 and Supplementary CAHPS PCMH. The results of these surveys were compared between readmitted and non-readmitted patients. Also, the differences between the primary care experiences of the pneumonia patient cohort and patients at the hospital system’s primary care sites were examined. Results showed that 5 patients out of the 33 patients surveyed were readmitted with non-pneumonia related causes. Patients across 18 primary care sites report higher levels of satisfaction with their PCP (88.7%) compared to patients hospitalized for Pneumonia (66.7%; X2 =14.9,

Multiple Brain Abscesses In A Child With Infective Endocarditis

Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38oc,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large