Ten key elements for implementing interprofessional learning in clinical simulations

This paper discusses 10 key elements for the design and implementation of interprofessional education (IPE) in a skills centre. The elements are based on published literature as well as on the experience of an IPE initiative, simulating the management of a multiple-traumatised patient in the acute and rehabilitation phases, by students from 4 professions: medicine, nursing, occupational therapy and physiotherapy. The key elements are interrelated and include the partners involved (learners, facilitators and patient simulator), the content, learning resources, setting, faculty development, logistics, learning strategies and evaluation

Pretoria medical students' perspectives on assessable attributes of Professionalism

Background Professionalism forms an important aspect of medicine's contract with society, and it is therefore important that it should be assessed and developed in medical schools. For the effective assessment of medical students' professionalism, clear objectives, or outcomes based on a clear definition of professionalism, have to be accepted by society, the faculty and the students. A Physician's Charter, ‘Medical Professionalism in the New Millennium‿, was published by the Annals of Internal Medicine in February 2002. Fifth-year medical students of the University of Pretoria were challenged to comment on the applicability of this Charter's principles and responsibilities in the South African context. The majority of the students did not fully agree with the principles and responsibilities. A following cohort of fifth-year students was requested to define professionalism and describe attributes that could be included in an assessment tool. Methods A qualitative design was employed to explore the students' perceptions. An analysis of the scripts was performed using qualitative content analysis. All the scripts were read twice and the emergent themes (attributes of professionalism) were identified by two researchers. The scripts were reviewed and coded independently to enhance reliability. Investigator triangulation, involving researchers with diverse research backgrounds, was done to validate the identified attributes. The themes were organised into categories (domains of professionalism). The authors discussed differing concepts with the other members of the Professional Attitude Development and Assessment Committee (PADAC) to arrive at a consensus. In the second stage of analysis, the identified themes were compared to the Charter. This was supported by quotations taken from the students' perceptions, as well as from the relevant literature. Tabulations were used to determine the frequencies of the different themes. Results The attributes used to describe professionalism were grouped under four main domains: attitude and personal conduct, teamwork, patient care and professional competence. These correspond, to some extent, with the Charter. Most of the students, however, stressed the humanistic attributes of professional behaviour, which are not mentioned in the Charter. These attributes include empathy, interpersonal relationships, integrity, respect, maturity and teamwork. Conclusion The students' perceptions of professionalism differed from that described in the Charter. The fact that the students value the humanistic part of professionalism could possibly be ascribed to the following factors: • Teaching of professionalism at the University of Pretoria focuses on the humanistic attributes, which form an important part of patient consultations and teamwork. • Medical students are not actively involved in the social contract that is prominent in the Charter. They have very little influence regarding social justice, access to care, distribution of resources and conflict of interest. • The Charter is considered vague and open to interpretation It is recommended that a universally acceptable charter be developed for the Medical School of Pretoria by involving faculty members to validate and accept the students' perspectives. It is also recommended that these mutually accepted attributes then be used as the assessment criteria of a professionalism assessment tool. This should also encourage faculty members to act as good role models. South African Family Practice Vol. 49 (4) 2007: pp.1

Lunar surface engineering properties experiment definition. Volume 1: Mechanics, properties, and stabilization of lunar soils

Lunar soil simulation and stabilization, and impact penetrometer studie

Impact of elosulfase alfa in patients with morquio A syndrome who have limited ambulation: An open-label, phase 2 study.

Efficacy and safety of elosulfase alfa enzyme replacement therapy (ERT) were assessed in an open-label, phase 2, multi-national study in Morquio A patients aged ≥5 years unable to walk ≥30 meters in the 6-min walk test. Patients received elosulfase alfa 2.0 mg/kg/week intravenously for 48 weeks. Efficacy measures were functional dexterity, pinch/grip strength, mobility in a modified timed 25-foot walk, pain, quality of life, respiratory function, and urine keratan sulfate (KS). Safety/tolerability was also assessed. Fifteen patients received elosulfase alfa, three patients discontinued ERT due to adverse events (two were grade 3 drug-related adverse events, the other was not drug-related), and two patients missed >20% of planned infusions; 10 completed treatment through 48 weeks and received ≥80% of planned infusions (Modified Per Protocol [MPP] population). The study population had more advanced disease than that enrolled in other trials. From baseline to week 48, MPP data showed biochemical efficacy (urine KS decreased 52.4%). The remaining efficacy results were highly variable due to challenges in test execution because of severe skeletal and joint abnormalities, small sample sizes, and clinical heterogeneity among patients. Eight patients showed improvements in one or more outcome measures; several patients indicated improvements not captured by the study assessments (e.g., increased energy, functional ability). The nature of adverse events was similar to other elosulfase alfa studies. This study illustrates the considerable challenges in objectively measuring impact of ERT in very disabled Morquio A patients and highlights the need to examine results on an individual basis. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc

Treatment of Comorbid Obesity and Major Depressive Disorder: A Prospective Pilot Study for their Combined Treatment

Background. Obese individuals who suffer from major depressive disorder are routinely screened out of weight loss trials. Treatments targeting obesity and depression concurrently have not been tested. Purpose. To test the short-term efficacy of a treatment that combined behavioral weight management and cognitive behavioral therapy (CBT) for obese adults with depression. Methods. Twelve obese females diagnosed with major depressive disorder received weekly group behavioral weight management, combined with CBT for depression, for 16 weeks. Weight, symptoms of depression, and cardiovascular disease (CVD) risk factors were measured at baseline and week 16. Results. Participants lost 11.4% of initial weight and achieved significant improvements in symptoms of depression and CVD risk factors. Conclusions. Obese individuals suffering from major depressive disorder can lose weight and achieve improvements in symptoms of depression and CVD risk factors with 16 weeks of combined treatment. A larger randomized controlled trial is needed to establish the efficacy of this treatment

Professionele geheimhouding

Confidentiality is a “sensitive” subject known to all professional nursing personnel. The perception of confidentiality in nursing students was determined during a research project. Some responses were surprising. The surprises were mostly due to the fast development in the medical and technology fields. These findings proved to be of significance in that guidelines for confidentiality are not up to date with the developments in these fields. These guidelines should be revised or rewritten to bring them up to date and help the professional nurse in decisions on aspects concerning confidentiality

Safety and physiological effects of two different doses of elosulfase alfa in patients with morquio a syndrome: A randomized, double-blind, pilot study.

The primary treatment outcomes of a phase 2, randomized, double-blind, pilot study evaluating safety, physiological, and pharmacological effects of elosulfase alfa in patients with Morquio A syndrome are herewith presented. Patients aged ≥7 years and able to walk ≥200 m in the 6-min walk test (6MWT) were randomized to elosulfase alfa 2.0 or 4.0 mg/kg/week for 27 weeks. The primary objective was to evaluate the safety of both doses. Secondary objectives were to evaluate effects on endurance (6MWT and 3-min stair climb test [3MSCT]), exercise capacity (cardio-pulmonary exercise test [CPET]), respiratory function, muscle strength, cardiac function, pain, and urine keratan sulfate (uKS) levels, and to determine pharmacokinetic parameters. Twenty-five patients were enrolled (15 randomized to 2.0 mg/kg/week and 10 to 4.0 mg/kg/week). No new or unexpected safety signals were observed. After 24 weeks, there were no improvements versus baseline in the 6MWT, yet numerical improvements were seen in the 3MSCT with 4.0 mg/kg/week. uKS and pharmacokinetic data suggested no linear relationship over the 2.0-4.0 mg/kg dose range. Overall, an abnormal exercise capacity (evaluated in 10 and 5 patients in the 2.0 and 4.0 mg/kg/week groups, respectively), impaired muscle strength, and considerable pain were observed at baseline, and there were trends towards improvements in all domains after treatment. In conclusion, preliminary data of this small study in a Morquio A population with relatively good endurance confirmed the acceptable safety profile of elosulfase alfa and showed a trend of increased exercise capacity and muscle strength and decreased pain

Call-Tracking Data and the Public Health Response to Bioterrorism-Related Anthrax

After public notification of confirmed cases of bioterrorism-related anthrax, the Centers for Disease Control and Prevention’s Emergency Operations Center responded to 11,063 bioterrorism-related telephone calls from October 8 to November 11, 2001. Most calls were inquiries from the public about anthrax vaccines (58.4%), requests for general information on bioterrorism prevention (14.8%), and use of personal protective equipment (12.0%); 882 telephone calls (8.0%) were referred to the state liaison team for follow-up investigation. Of these, 226 (25.6%) included reports of either illness clinically confirmed to be compatible with anthrax or direct exposure to an environment known to be contaminated with Bacillus anthracis. The remaining 656 (74.4%) included no confirmed illness but reported exposures to “suspicious” packages or substances or the receipt of mail through a contaminated facility. Emergency response staff must handle high call volumes following suspected or actual bioterrorist attacks. Standardized health communication protocols that address contact with unknown substances, handling of suspicious mail, and clinical evaluation of suspected cases would allow more efficient follow-up investigations of clinically compatible cases in high-risk groups

HIV Prevalence and Incidence among Sexually Active Females in Two Districts of South Africa to Determine Microbicide Trial Feasibility

Background: The suitability of populations of sexually active women in Madibeng (North-West Province) and Mbekweni (Western Cape), South Africa, for a Phase III vaginal microbicide trial was evaluated. Methods: Sexually active women 18-35 years not known to be HIV-positive or pregnant were tested cross-sectionally to determine HIV and pregnancy prevalence (798 in Madibeng and 800 in Mbekweni). Out of these, 299 non-pregnant, HIV-negative women were subsequently enrolled at each clinical research center in a 12-month cohort study with quarterly study visits. Results: HIV prevalence was 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months were 6.0/100 person-years (PY) (95% CI 3.0, 9.0) in Madibeng and 4.5/100 PY (95% CI 1.8, 7.1) in Mbekweni and those estimated by cross-sectional BED testing were 7.1/100 PY (95% CI 2.8, 11.3) in Madibeng and 5.8/100 PY (95% CI 2.0, 9.6) in Mbekweni. The 12-month pregnancy incidence rates were 4.8/100 PY (95% CI 2.2, 7.5) in Madibeng and 7.0/100 PY (95% CI 3.7, 10.3) in Mbekweni; rates decreased over time in both districts. Genital symptoms were reported very frequently, with an incidence of 46.8/100 PY (95% CI 38.5, 55.2) in Madibeng and 21.5/100 PY (95% CI 15.8, 27.3) in Mbekweni. Almost all (>99%) participants said that they would be willing to participate in a microbicide trial. Conclusion: These populations might be suitable for Phase III microbicide trials provided that HIV incidence rates over time remain sufficiently high to support endpoint-driven trial