Development and Evolution of a Model Interprofessional Education Program in Parkinson’s disease: A Ten-year Experience

OBJECTIVE This paper describes development, evolution and learner reactions in a model interprofessional education program for medical, nursing, physician assistant, occupational therapy, physical therapy, music therapy, social work and speech-language pathology practitioners. Sponsored by the National Parkinson Foundation (NPF) (currently Parkinson’s Foundation), Allied Team Training for Parkinson (ATTP) is a U.S.-based multi-day interprofessional education program in best practices for integrated, interprofessional team-based Parkinson’s disease (PD) care. NPF sponsored 26 ATTP trainings from 2003 to 2013. METHODS This mixed methods evaluation uses case study document review and observation to outline ATTP curriculum development, evolution, and implementation challenges. Learner-perceived effectiveness ratings, knowledge change, pre-post ratings on the Team Skills Scale, confidence in working with people with PD and caregivers, and trainee-reported practice changes at 6-month follow-up were collected. RESULTS Qualitative results identified multiple factors in building an effective interprofessional education program, including interprofessional team practice opportunities through case-based learning, engaging care networks and continuous feedback loops for program improvement. Quantitative results showed that trainees across professions, geographic regions and work settings rated the overall program and curriculum effectiveness, amount of new knowledge and knowledge change very highly. ATTP resulted in significant post-training improvement in team skills, confidence in working with PD, and post-training self-reported practice changes. CONCLUSION Findings suggest that ATTP is an effective interprofessional education program that could be replicated or adapted to other settings and neurodegenerative or chronic illnesses. The model of combining interprofessional team training with disease-specific curriculum content appears to be an effective “next practice” in continuing professional development

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

A Tool For Explaining The Differences on Renneting Characteristics of Milks From Different Origins: The Surface Hydrophobicity Approach

The differences between renneting characteristics of raw milk samples from different origins (bovine, ovine, caprine, buffalo) were investigated by protein surface hydrophobicity approach. 8-Anilinonaphthalene-1-sulfonic acid (ANS) binding method was used to evaluate surface hydrophobicity of raw milk samples and rennet precipitates. The following surface hydrophobicity parameters were calculated: number of surface hydrophobic sites (F (max)), dissociation constant of the fluorescent ANS-protein complex (K (d)), binding affinity of ANS to protein surface (1/K (d)), the average tightness of binding of ANS to the protein (F (max)/K (d)), turnover number (k (cat)), and protein surface hydrophobicity index (PSHI). The number of hydrophobic sites on the protein surface was found to be highest in cow milk, whereas ovine milk samples had the lowest number of hydrophobic sites and binding affinity to ANS. Protein content was not found directly related to the number of surface hydrophobic sites. The binding affinity of the proteins to ANS was greater in buffalo milk. PSHI was found to be the highest for bovine milk and the lowest for ovine milk. Renneting period was interpreted in two phases (enzymatic phase and flocculation phase) for each origin via ANS partition curves of rennet precipitates. Same trends between bovine-ovine and caprine-buffalo milks were observed during renneting. Buffalo milk completed both of two phases and total renneting period significantly earlier than the milks from the other origins. The hydrophobic parameters of proteins were found to play a key role on coagulation properties.Wo