Addressing Opioid Misuse and Abuse through Interprofessional Engagement and Education

Purpose: The purpose of this initiative was to develop and implement an interprofessional panel aimed to expose a university audience to the magnitude of opioid misuse and abuse, as well as demonstrate each health professional’s role in curbing the epidemic. Further, this experience was to provide a platform for interprofessional discussion and to share with attendees tangible action items to begin combatting the opioid epidemic. Methods: An interdisciplinary committee of healthcare professionals collaborated to initiate a dialogue around opioid misuse and abuse to highlight the power of interprofessional (IP) collaboration in addressing the opioid epidemic. Each panel member shared a personal vignette about his or her professional experience with the epidemic, then the audience members were asked to participate in a question and answer session. Primary outcomes from this IP experience were derived from an eight-item satisfaction survey. The event was held in April 2016. The interdisciplinary committee marketed this event to all students, faculty, and staff in the Rueckert-Hartman College of Health Care Professionals one month before the event through electronic emails and posters. Results: Forty-four (63%) of participants completed the satisfaction survey of which 88.6% were students of healthcare professions. The satisfaction survey evaluative results were positive and referenced the panel as being an excellent IP event that was helpful, informative, and enjoyable. The results support that the initiative successfully increased understanding of the magnitude of the opioid epidemic for the attendees of this pilot event. The target audience of students expressed a greater awareness of the magnitude of the problem (43.2%) and an increased appreciation of the IP aspects of opioid management strategies (36.4%). Attendees also identified the need for ownership of their role as existing and future health care professionals and the need to work as an IP team to address the problem. Conclusion: An interprofessional panel format as an optional extracurricular event is an effective way to communicate key educational messages about opioid misuse and abuse to a target audience of graduate students at a mid-sized college of health professions

A Journey from Patient Care to Jesuit Higher Education: How a Small Group of Healthcare Professionals Navigated the Transition into Academia

In the fall of 2015, four experienced healthcare clinicians met as strangers at an orientation at a Jesuit institution, Regis University. From the professions of occupational therapy, pharmacy, and physical therapy, we felt comfortable with our clinical practice in patient-centered care and our healthcare work environments. Eager to share our knowledge with our students, we needed guidance to perform the key roles of an educator such as creating a syllabus, writing test items, and advising students. As we began our careers in academia, we felt disoriented and chaotic. We directly sought structure to bridge knowledge gaps, establish a sense of community, and identify essential resources necessary for success in academia. We desired to explore our own interpretation of the Jesuit values before trying to infuse them into our teaching. Through the creation of a small professional learning group that combined emotional support and professional growth, we established a structured approach to learning the roles of a professor and found our identities as academicians. We aim to share our journey and provide recommendations for other healthcare clinicians who are inexperienced with academia in the hopes of easing the transition from clinician to educator at a Jesuit University

Effects on Breathing of Agonists to μ-opioid or GABA\u3csub\u3eA\u3c/sub\u3e Receptors Dialyzed into the Ventral Respiratory Column of Awake and Sleeping Goats

Pulmonary ventilation (V̇I) in awake and sleeping goats does not change when antagonists to several excitatory G protein-coupled receptors are dialyzed unilaterally into the ventral respiratory column (VRC). Concomitant changes in excitatory neuromodulators in the effluent mock cerebral spinal fluid (mCSF) suggest neuromodulatory compensation. Herein, we studied neuromodulatory compensation during dialysis of agonists to inhibitory G protein-coupled or ionotropic receptors into the VRC. Microtubules were implanted into the VRC of goats for dialysis of mCSF mixed with agonists to either μ-opioid (DAMGO) or GABAA (muscimol) receptors. We found: (1) V̇I decreased during unilateral but increased during bilateral dialysis of DAMGO, (2) dialyses of DAMGO destabilized breathing, (3) unilateral dialysis of muscimol increased V̇I, and (4) dialysis of DAMGO decreased GABA in the effluent mCSF. We conclude: (1) neuromodulatory compensation can occur during altered inhibitory neuromodulator receptor activity, and (2) the mechanism of compensation differs between G protein-coupled excitatory and inhibitory receptors and between G protein-coupled and inotropic inhibitory receptors

State-Dependent and -Independent Effects of Dialyzing Excitatory Neuromodulator Receptor Antagonists into the Ventral Respiratory Column

Unilateral dialysis of the broad-spectrum muscarinic receptor antagonist atropine (50 mM) into the ventral respiratory column [(VRC) including the pre-Bötzinger complex region] of awake goats increased pulmonary ventilation (V̇i) and breathing frequency (f), conceivably due to local compensatory increases in serotonin (5-HT) and substance P (SP) measured in effluent mock cerebral spinal fluid (mCSF). In contrast, unilateral dialysis of a triple cocktail of antagonists to muscarinic (atropine; 5 mM), neurokinin-1, and 5-HT receptors does not alter V̇i or f, but increases local SP. Herein, we tested hypotheses that 1) local compensatory 5-HT and SP responses to 50 mM atropine dialyzed into the VRC of goats will not differ between anesthetized and awake states; and 2) bilateral dialysis of the triple cocktail of antagonists into the VRC of awake goats will not alter V̇i or f, but will increase local excitatory neuromodulators. Through microtubules implanted into the VRC of goats, probes were inserted to dialyze mCSF alone (time control), 50 mM atropine, or the triple cocktail of antagonists. We found 1) equivalent increases in local 5-HT and SP with 50 mM atropine dialysis during wakefulness compared with isoflurane anesthesia, but V̇i and f only increased while awake; and 2) dialyses of the triple cocktail of antagonists increased V̇i, f, 5-HT, and SP

Perceived Water Quality and Reported Health among Adults during the Flint, MI Water Crisis

Background and Purpose: In April 2014, the municipal water source for Flint, Michigan was changed from Lake Huron to the Flint River. Although residents reported concerns about the quality of tap water and resulting health problems, officials insisted that the water was safe. This study examined relationships between self-reported tap water quality during the water crisis and health conditions among Flint residents. Methods: Participants from each residential Census Tract in the City of Flint were recruited via address lists, online social media, and community-based events. The survey included mental and physical health items from the CDC’s Behavioral Risk Factor Surveillance System and an item on tap water quarter quality experiences. Analyses were weighted to be demographically representative. Results: Participants (N = 277) rated their tap water quality (taste, smell, appearance) as Poor (57%), Fair (20%), Good (13%), Very Good (6%), and Excellent (3%). Controlling for age, gender, years of education, whether respondents were African American or Hispanic/Latino/a, and population demographics, lower perceived tap water quality was associated with worse mental and physical health across all indicators. Conclusion: This study demonstrates associations of tap water quality experiences with reported poor physical and mental health among adults in Flint during the Flint Water Crisis

Cytotoxic clinical isolates of Pseudomonas aeruginosa identified during the Steroids for Corneal Ulcers Trial show elevated resistance to fluoroquinolones.

BackgroundTo determine the relationship between type three secretion genotype and fluoroquinolone resistance for P. aeruginosa strains isolated from microbial keratitis during the Steroids for Corneal Ulcers Trial (SCUT) and for two laboratory strains, PA103 and PAO1.MethodsConfirmed P. aeruginosa isolates from the SCUT were divided into exoU(+) or exoU(-). The exoU(+) strains contained the gene encoding ExoU, a powerful phospholipase toxin delivered into host cells by the type three secretion system. Isolates were then assessed for susceptibility to fluoroquinolone, cephalosporin, and aminoglycoside antibiotics using disk diffusion assays. Etest was used to determine the MIC of moxifloxacin and other fluoroquinolones. Laboratory isolates in which the exoU gene was added or deleted were also tested.ResultsA significantly higher proportion of exoU(+) strains were resistant to ciprofloxacin (p = 0.001), gatifloxacin (p = 0.003), and ofloxacin (p = 0.002) compared to exoU(-) isolates. There was no significant difference between exoU(+) or exoU(-) negative isolates with respect to susceptibility to other antibiotics except gentamicin. Infections involving resistant exoU(+) strains trended towards worse clinical outcome. Deletion or acquisition of exoU in laboratory isolates did not affect fluoroquinolone susceptibility.ConclusionsFluoroquinolone susceptibility of P. aeruginosa isolated from the SCUT is consistent with previous studies showing elevated resistance involving exoU encoding (cytotoxic) strains, and suggest worse clinical outcome from infections involving resistant isolates. Determination of exoU expression in clinical isolates of P. aeruginosa may be helpful in directing clinical management of patients with microbial keratitis