Effectiveness of Clinical Scenarios in Improving Student Interprofessional Skills and Attitudes

Background: “Interprofessional education (IPE) is defined as the process by which individuals from two or more health professions learn with, from, and about each other across the spectrum of their education to improve collaboration, practice, and the quality of health care.” [1] Interprofessional Education has recently gained interest as an important aspect of training in healthcare professions, attracting the attention and support of several key pharmacy organizations. Various models of IPE have been implemented to facilitate collaboration among medical, nursing, pharmacy, and social work students and professionals. One model found to be particularly effective among pharmacy students is a mock clinical scenario, requiring interprofessional collaboration in order to yield the best care for the patient. Objectives: Therefore, the aim of this project is to utilize mock clinical scenarios to improve interprofessional knowledge, collaboration, student attitudes, and behaviors among Cedarville pharmacy, nursing, and social work students and Wright State medical students. The long term goal is to integrate this clinical scenario model, if proven effective, into the interprofessional curriculums of emerging health science centers. Methodology: The study will conduct mock clinical scenarios among pharmacy, nursing, social work, and medical students. The participants will complete a survey prior to the event regarding interprofessional behaviors and attitudes. The volunteers will then complete the scenario in intraprofessional groups. Following the intraprofessional session another survey will be taken to determine any changes in attitudes and behaviors. The subjects will then complete the scenario again in interprofessional groups. Following the interprofessional session a final survey will be administered to further measure change in attitudes and behaviors. Both sessions will be 20 minutes, and participants will be given 5 minutes to complete each survey. Analysis: Analysis will be conducted with the Kruskall-Wallis test to find change in attitudes among the students among the different majors. Also, the Wilcoxon signed-rank test will determine changes within each group since normal distribution will not be assumed

Evaluating Interprofessional Fast Forward Rounds for Transition of Care Education

Background: Interprofessional Education is gaining recognition by key pharmacy organizations for its value in healthcare education, producing various models for implementation among healthcare students and professionals. Unfolding cases incorporating transitions of care may improve student skills and attitudes toward interprofessional collaboration. Objectives: This project assessed the efficacy of unfolding cases in improving interprofessional skills and attitudes among pharmacy, nursing, and social work students. The ultimate goal is to integrate this model, if proven effective, into the curricula of multiple health science centers. Methodology: First, pharmacy, nursing, and social work students completed a pre-intervention survey regarding interprofessional skills and attitudes before discussing the first “fast-forward rounds” case in professional silos. After a transitions of care lecture, subjects completed the alternative cases in interprofessional groups in a crossover design. The comparable transitions of care cases included common healthcare topics that were challenging but within the scope of regular practice. “Fast forwards” between transitions of care required students to interpret changes in the case throughout the hospital stay. Following the interprofessional session, group debriefing allowed for feedback on cases, transitions, and differences working with and without other professions. Finally, a post-intervention survey was administered to measure changes in interprofessional attitudes and skills. Analysis: Kruskall-Wallis analysis identified differences among the three majors on the pretest and posttest separately. The Wilcoxon sign rank test assessed changes within each group since normal distribution was not assumed. A Chi-squared test analyzed demographic data. Results: Data analysis of results from the conference revealed a significant improvement in 15 of 25 survey questions in the composite group, while 14, 7, and 4 questions showed significant improvement in the pharmacy, nursing, and social work sub-analyses, respectively. Fewer questions showed significant improvement in the social work group, possibly due to the specific medical details of the cases as well as fewer social work participants relative to pharmacy and nursing. Discussion: Results suggest that this intervention can effectively improve student attitudes toward interprofessional collaboration and understanding of transitions of care. Changes can be made to improve the benefit to social work students and to increase the number of majors participating

Factors Influencing Emergency Contraception Use in Indigent Populations

Introduction: Indigent women are disproportionately affected by unwanted, unplanned pregnancies. Studies previously identified lack of knowledge about emergency contraception (EC) as a major deterrent from use. This study was performed to address three potential barriers to the use of EC in indigent populations: culture and religion, patient education, and cost. For the entirety of this study, EC refers to levonorgestrel (LNG). Objectives: To determine the impact of culture and religion, patient education, and cost on EC use in the indigent population. Methods: This study was a cross-sectional observational study to explore and investigate relationships between indigent populations and the use of EC. To be included in the study, participants had to be: at least 14 years old, female, and have an annual household income below the federal poverty line (FPL). Those excluded were less than 14 years old, male, and reported an annual household income above the FPL. A questionnaire consisting of 31 survey questions were utilized to assess the endpoints of the study. The study utilized both paper and electronic forms of the survey. Participants signed informed consent to enable them participate in the study. Out of 319 participants, 59 met all inclusion criteria and were used in statistical analyses. Results:Based on Kruskal-Wallis results, religious groups’ acceptance of EC influenced indigent women’s decision to use it (p=0.016). Level of education also influenced women’s understanding of EC as an abortifacient and knowledge of when LNG is effective. Spearman rho revealed correlations between participants’ willingness to pay for EC or routine birth control and knowing that EC was an option (coefficient 0.391; p-value 0.005). There was also a correlation between the cost of EC and ultimate use (coefficient -0.603; p-value Conclusion: Our research found that religious groups’ acceptance of EC use and knowledge about how LNG works does affect the decision to use EC. Neither cultural identification nor cost of EC appears to have a significant impact on the final decision to use

Trial protocol OPPTIMUM : does progesterone prophylaxis for the prevention of preterm labour improve outcome?

Background Preterm birth is a global problem, with a prevalence of 8 to 12% depending on location. Several large trials and systematic reviews have shown progestogens to be effective in preventing or delaying preterm birth in selected high risk women with a singleton pregnancy (including those with a short cervix or previous preterm birth). Although an improvement in short term neonatal outcomes has been shown in some trials these have not consistently been confirmed in meta-analyses. Additionally data on longer term outcomes is limited to a single trial where no difference in outcomes was demonstrated at four years of age of the child, despite those in the “progesterone” group having a lower incidence of preterm birth. Methods/Design The OPPTIMUM study is a double blind randomized placebo controlled trial to determine whether progesterone prophylaxis to prevent preterm birth has long term neonatal or infant benefit. Specifically it will study whether, in women with singleton pregnancy and at high risk of preterm labour, prophylactic vaginal natural progesterone, 200 mg daily from 22 – 34 weeks gestation, compared to placebo, improves obstetric outcome by lengthening pregnancy thus reducing the incidence of preterm delivery (before 34 weeks), improves neonatal outcome by reducing a composite of death and major morbidity, and leads to improved childhood cognitive and neurosensory outcomes at two years of age. Recruitment began in 2009 and is scheduled to close in Spring 2013. As of May 2012, over 800 women had been randomized in 60 sites. Discussion OPPTIMUM will provide further evidence on the effectiveness of vaginal progesterone for prevention of preterm birth and improvement of neonatal outcomes in selected groups of women with singleton pregnancy at high risk of preterm birth. Additionally it will determine whether any reduction in the incidence of preterm birth is accompanied by improved childhood outcome

Association of diuretic use and overactive bladder syndrome in older adults: A propensity score analysis

Diuretics use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n = 172) had a mean age of 79 ± 7.5 (± S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients respectively reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio = OR = 3.48; 95% confidence interval = CI = 1.73–7.03) and urgency (74% versus 57% non-diuretic; OR = 2.17; 95% CI = 1.11–4.24) but not with incontinence (OR = 1.74; 95% CI = 0.87–3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR = 3.09; 95% CI = 1.20–7.97) and urgency (adjusted OR = 2.50; 95% CI = 1.00–6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR = 2.54; 95% CI = 1.09–5.91), which lost significance after propensity adjustment (adjusted OR = 1.88; 95% CI = 0.57–6.17). Overall summary mean Urge-IIQ score was 1.83 ± 0.85 (±S.D.) with 1.75 ± 0.86, 1.68 ± 0.76, and 2.03 ± 0.88, respectively for no-diuretic, non-loop, and loop-diuretic patients (one-way ANOVA p = 0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use

Enzymatically Degradable Mussel-Inspired Adhesive Hydrogel

Mussel-inspired adhesive hydrogels represent innovative candidate medical sealants or glues. In the present work, we describe an enzyme-degradable mussel-inspired adhesive hydrogel formulation, achieved by incorporating minimal elastase substrate peptide Ala-Ala into the branched poly(ethylene glycol) (PEG) macromonomer structure. The system takes advantage of neutrophil elastase expression upregulation and secretion from neutrophils upon recruitment to wounded or inflamed tissue. By integrating adhesive degradation behaviors that respond to cellular cues, we expand the functional range of our mussel-inspired adhesive hydrogel platforms. Rapid (<1 min) and simultaneous gelation and adhesion of the proteolytically active, catechol-terminated precursor macromonomer was achieved by addition of sodium periodate oxidant. Rheological analysis and equilibrium swelling studies demonstrated that the hydrogel is appropriate for soft tissue-contacting applications. Notably, hydrogel storage modulus (G) achieved values on the order of 10 kPa, and strain at failure exceeded 200% strain. Lap shear testing confirmed the materials adhesive behavior (shear strength: 30.4 ± 3.39 kPa). Although adhesive hydrogel degradation was not observed during short-term (27 h) in vitro treatment with neutrophil elastase, in vivo degradation proceeded over several months following dorsal subcutaneous implantation in mice. This work represents the first example of an enzymatically degradable mussel-inspired adhesive and expands the potential biomedical applications of this family of materials

The DOE E3SM Coupled Model Version 1: Overview and Evaluation at Standard Resolution

This work documents the first version of the U.S. Department of Energy (DOE) new Energy Exascale Earth System Model (E3SMv1). We focus on the standard resolution of the fully coupled physical model designed to address DOE mission-relevant water cycle questions. Its components include atmosphere and land (110-km grid spacing), ocean and sea ice (60 km in the midlatitudes and 30 km at the equator and poles), and river transport (55 km) models. This base configuration will also serve as a foundation for additional configurations exploring higher horizontal resolution as well as augmented capabilities in the form of biogeochemistry and cryosphere configurations. The performance of E3SMv1 is evaluated by means of a standard set of Coupled Model Intercomparison Project Phase 6 (CMIP6) Diagnosis, Evaluation, and Characterization of Klima simulations consisting of a long preindustrial control, historical simulations (ensembles of fully coupled and prescribed SSTs) as well as idealized CO2 forcing simulations. The model performs well overall with biases typical of other CMIP-class models, although the simulated Atlantic Meridional Overturning Circulation is weaker than many CMIP-class models. While the E3SMv1 historical ensemble captures the bulk of the observed warming between preindustrial (1850) and present day, the trajectory of the warming diverges from observations in the second half of the twentieth century with a period of delayed warming followed by an excessive warming trend. Using a two-layer energy balance model, we attribute this divergence to the model’s strong aerosol-related effective radiative forcing (ERFari+aci = -1.65 W/m2) and high equilibrium climate sensitivity (ECS = 5.3 K).Plain Language SummaryThe U.S. Department of Energy funded the development of a new state-of-the-art Earth system model for research and applications relevant to its mission. The Energy Exascale Earth System Model version 1 (E3SMv1) consists of five interacting components for the global atmosphere, land surface, ocean, sea ice, and rivers. Three of these components (ocean, sea ice, and river) are new and have not been coupled into an Earth system model previously. The atmosphere and land surface components were created by extending existing components part of the Community Earth System Model, Version 1. E3SMv1’s capabilities are demonstrated by performing a set of standardized simulation experiments described by the Coupled Model Intercomparison Project Phase 6 (CMIP6) Diagnosis, Evaluation, and Characterization of Klima protocol at standard horizontal spatial resolution of approximately 1° latitude and longitude. The model reproduces global and regional climate features well compared to observations. Simulated warming between 1850 and 2015 matches observations, but the model is too cold by about 0.5 °C between 1960 and 1990 and later warms at a rate greater than observed. A thermodynamic analysis of the model’s response to greenhouse gas and aerosol radiative affects may explain the reasons for the discrepancy.Key PointsThis work documents E3SMv1, the first version of the U.S. DOE Energy Exascale Earth System ModelThe performance of E3SMv1 is documented with a set of standard CMIP6 DECK and historical simulations comprising nearly 3,000 yearsE3SMv1 has a high equilibrium climate sensitivity (5.3 K) and strong aerosol-related effective radiative forcing (-1.65 W/m2)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151288/1/jame20860_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151288/2/jame20860.pd

Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation

Objectives: No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods: In a large cohort of HIV-positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD4 count at the initiation of cART. Results: Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 count > 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD4 count < 350 cells/μL. Conclusions: We found no evidence of increased rates of resistance development when cART was initiated at CD4 counts above 350 cells/μL. HIV Medicin