The Development of a Novel Interprofessional Education Curriculum for third year medical and pharmacy students

Abstract Introduction: The Liaison Committee on Medical Education and the Accreditation Council for Pharmacy Education, agencies responsible for the accreditation of medical and pharmacy schools respectively, require interprofessional education (IPE) to be integrated into both curricula. Institutions are given the autonomy to design and implement this requirement, however research is equivocal in regards to when and how best to implement IPE. The development of a new IPE curriculum is often met with a number of challenges, such as a lack of faculty support and resources. Methods: This study describes a newly created pilot IPE curriculum developed with minimal existing organizational IPE structure and resources, led by faculty champions from two complementary healthcare professions, Internal Medicine and Pharmacy. The validated 10-item Student Perceptions of Interprofessional Clinical Education- Revised (SPICE-R) instrument was used to assess the medical and pharmacy students’ attitudes towards interprofessional healthcare teams and the team approach to patient care. Results: Overall, students demonstrated a statistically significant increase in their perception of interprofessional healthcare teams and team approach to patient care. Conclusion: Prior to this IPE curriculum no formal IPE curriculum existed in this setting. This IPE curriculum was successfully implemented with minimal existing resources, the use of faculty champions and student’s perception of IPE improved using the validated SPICE-R instrument. IPE curriculum integration at our institution is in various stages of development. As IPE integration moves forward this pilot can serve as one example of how IPE could be implemented

Antagonism of ␦ 2 -Opioid Receptors by Naltrindole-5Ј- isothiocyanate Attenuates Heroin Self-Administration but Not Antinociception in Rats 1

ABSTRACT ␦-Opioid receptors have been implicated in reinforcement processes and antagonists are available that produce long-lasting and selective antagonism of ␦-opioid receptors in vivo. This experiment assessed the contribution of ␦-opioid receptors to the antinociceptive and reinforcing properties of heroin. The effects of the irreversible ␦-antagonist naltrindole-5Ј-isothiocyanate (5Ј-NTII) were evaluated on heroin self-administration and hot-plate antinociception in rats. 5Ј-NTII (10 nmol i.c.v.) shifted the dose-response curve for heroin self-administration downward, increasing the A 50 values on the ascending and descending limbs by approximately 0.5 log units and decreasing the maximum by 33%. 5Ј-NTII (40 nmol i.c.v.) shifted both limbs of the heroin self-administration dose-effect curve 1.2 log units to the right and decreased the maximum by 90%. Heroin self-administration gradually returned to baseline levels over 7 or 17 days after administration of 10 or 40 nmol 5Ј-NTII, respectively. 5Ј-NTII (40 nmol i.c.v.) decreased the self-administration of 0.17 mg/infusion cocaine by 40% while having no effect on responding maintained by 0.33 or 0.67 mg/infusion. 5Ј-NTII attenuated the antinociceptive effects of deltorphin (␦ 2 ) in a dose-dependent manner while having no effect on antinociception elicited after i

On the effects of noncontingent delivery of differing magnitudes of reinforcement.

We conducted a parametric analysis of response suppression associated with different magnitudes of noncontingent reinforcement (NCR). Participants were 5 adults with severe or profound mental retardation who engaged in a manual response that was reinforced on variable-ratio schedules during baseline. Participants were then exposed to NCR via multielement and reversal designs. The fixed-time schedules were kept constant while the magnitude of the reinforcing stimulus was varied across three levels (low, medium, and high). Results showed that high-magnitude NCR schedules produced large and consistent reductions in response rates, medium-magnitude schedules produced less consistent and smaller reductions, and low-magnitude schedules produced little or no effect on responding. These results suggest that (a) NCR affects responding by altering an establishing operation (i.e., attenuating a deprivation state) rather than through extinction, and (b) magnitude of reinforcement is an important variable in determining the effectiveness of NCR

Optimising pyrazinamide for the treatment of tuberculosis

Pyrazinamide is a potent sterilising agent that shortens the treatment duration needed to cure tuberculosis. It is synergistic with novel and existing drugs for tuberculosis. The dose of pyrazinamide that optimises efficacy while remaining safe is uncertain, as is its potential role in shortening treatment duration further.Pharmacokinetic data, sputum culture, and safety laboratory results were compiled from Tuberculosis Trials Consortium (TBTC) studies 27 and 28 and Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (PanACEA) multi-arm multi-stage tuberculosis (MAMS-TB), multi-centre phase 2 trials in which participants received rifampicin (range 10-35 mg·kg-1), pyrazinamide (range 20-30 mg·kg-1), plus two companion drugs. Pyrazinamide pharmacokinetic-pharmacodynamic (PK-PD) and pharmacokinetic-toxicity analyses were performed.In TBTC studies (n=77), higher pyrazinamide maximum concentration (Cmax) was associated with shorter time to culture conversion (TTCC) and higher probability of 2-month culture conversion (p-value<0.001). Parametric survival analyses showed that relationships varied geographically, with steeper PK-PD relationships seen among non-African than African participants. In PanACEA MAMS-TB (n=363), TTCC decreased as pyrazinamide Cmax increased and varied by rifampicin area under the curve (p-value<0.01). Modelling and simulation suggested that very high doses of pyrazinamide (>4500 mg) or increasing both pyrazinamide and rifampicin would be required to reach targets associated with treatment shortening. Combining all trials, liver toxicity was rare (3.9% with grade 3 or higher liver function tests (LFT)), and no relationship was seen between pyrazinamide Cmax and LFT levels.Pyrazinamide's microbiological efficacy increases with increasing drug concentrations. Optimising pyrazinamide alone, though, is unlikely to be sufficient to allow tuberculosis treatment shortening; rather, rifampicin dose would need to be increased in parallel