Impact of Program Review on IPE Programming and Assessment

Purpose: Efforts to measure the effectiveness of Interprofessional Practice and Education (IPE) are challenging. We will present how formal program review can measure IPE effectiveness and lead to improvements in programming and assessment. Background: Western University of Health Sciences requires program review of curricular programs. The IPE curriculum recently underwent program review. External reviewers shared the results of their evaluations with university administration and deans. Their specific recommendations led to a retreat and development of a vision statement for IPE and the development of a new clinical assessment tool. Description of Intervention: After program review and receipt of the reviewers’ recommendations a full day retreat was held with senior administration and Deans from all health professions programs. Through these efforts a new IPE program vision statement was re-stated with reaffirmed commitments from all present. Preliminary Results: A shared vision statement was developed and finalized, which led to re-prioritizing core and key competencies to be used in the IPE curriculum. The revised core competencies were circulated via electronic survey to clinical practice sites where preceptors provided feedback and comments so that the competencies adequately defined measurable skills and behaviors could be used as assessment tools during clinical rotations. Relevance to Interprofessional Education or Practice: Program review can have an impact on the development of a shared university IPE vision and the identification of measurable IPE behaviors and skills important to the field. Recommendation for future investigation or incorporation into education: Outcomes from the new assessment tool will be compiled and analyzed with respect to use in clinical education across health professions. Learning Objectives: 1) Describe how formal university program review can used to renew senior administration commitment to IPE and to improve assessment practices. 2) Reflect on how program review can be instituted in any institution with an IPE program

Some Contributions of Medical Theory to the Discovery of the Conservation of Energy Principle During the Late 18th and Early 19th Centuries

Several scholars have investigated contributions that medical theorists made during the 19th century to the discovery of the conservation of energy. This thesis investigates such contributions, particularly in Britain and Germany, in greater detail than has been done hitherto. Beginning with ideas on POW8L of 17th and 18th century British philosophers, the development of an interest in dynamics is traced through the writings of some two dozen British medical theorists between about 1760 and 1860. Gradually their ideas on power or force – these two words were usually synonymous - became sharper, and by the l830s the parallel studies on force in the physical sciences were influencing them considerably. Thus, in the 1840s William Robert Grove's (1811- 1896) formal enunciation of the correlation of forces seemed to give physiologists extra confidence in their ideas, especially on the correlation of physical and vital forces and the noncreatibility and indestructibility of power in the living organism. Two physiologists in particular have been discussed as illustrations of how readily the formally enunciated principles of the correlation of forces and the conservation of energy were applied to their physiology in the 1840s and 1850s. Part II of the thesis discusses the growth of dynamical physiology in Germany, focussing on some half dozen physiologists. Since these men were influenced strongly by 18th century German philosophy, particularly by Naturphilosophie, a chapter has been given to sketching their philosophical heritage from Benedict Spinoza (1632-1677) to Immanuel Kant (1724-1804). Like their British contemporaries, their dynamics were often vague, but by the l830s they too benefitted from the dynamical studies in physics. Finally, several of these German physiologists enunciated clearly their own form of the conservation principle; Julius Robert Mayer (1814-1878), Hermann Helmholtz (1821-1894) and Justus Liebig (1803-1873) are the best known of them. The conclusion of this thesis is that there were physiologists In Britain and Germany during the late 18th and early 19th centuries whose interests in the dynamics of life crystallized in the closely related principles of the correlation of forces and the conservation of energy

Nonstandard Radiographic Techniques for the Equine Practitioner

The diagnostic capabilities of the equine practitioner can be greatly increased with the use of nonstandard radiographic projections that are designed to enhance specific locations within a designated anatomical region. These techniques can easily be performed by using standard portable radiographic equipment. Author's address: New Jersey Equine Clinic, 384 Millstone Rd., Clarksburg, NJ 08510. 1997 AAEP

Cost-Effectiveness Analysis of Canine Heartworm Preventive Products

Heartworm disease in domestic dogs is a preventable disease caused by infection with the parasite, Dirofilaria immitis, that can lead to severe pulmonary and cardiac disease. Prevention is through consistent use of FDA-approved heartworm preventive (HWP) products. Banfield® Pet Hospital (Banfield PH), the largest network of primary care small animal hospitals in the United States, carries 11 HWP products for dogs in its formulary. Preliminary research provide evidence that rates of “breakthrough” infections differ by the route of HWP product administration and that (previously) infected dogs that were treated to clear the infection are still at higher risk of cardiac disease later in life, emphasizing importance of prevention. A cost-effectiveness analysis was conducted to evaluate HWP product categories, based on their route of administration, and owner lifetime cost to prevent and/or treat heartworm infection with years-of-life gained (YLG) as the outcome. Comparing injectable extended release (6- or 12-month) products and monthly topical or oral products to receipt of no HWP product, the analysis revealed that expected owner costs and patient outcome did not differ greatly between the product categories with an estimated gain of 1.4 months of life if they received HWP products. The incremental cost-effectiveness analysis estimates that average dog owner cost of $7,500+ per YLG regardless of product category. Evaluating reasonable cost for HWP products for a disease that may cost$3,000+ (out-of-pocket) to treat is difficult, as willingness-to-pay thresholds or accepted estimates for value of a pet’s life beyond fair market value have not been established. While no obvious indication that HWP product categories are more cost-effective, the analysis demonstrates the potential of this approach to compare individual products to inform decision-making for product selection and pricing in Banfield PH and the veterinary industry

Pre-trilostane and 3-hour post-trilostane cortisol to monitor trilostane therapy in dogs

It is recommended that trilostane therapy of canine hyperadrenocorticism is monitored using an ACTH stimulation test, however this has never been validated. Three cortisol concentrations (pre-trilostane, 3-hour posttrilostane and 1-hour post-ACTH stimulation) were compared to a clinical score obtained from an owner questionnaire. There were 110 sets of 3 cortisol measurements and questionnaires obtained from 67 trilostane treated dogs. Questionnaire results were used to classify each dog as well or unwell. Well dogs were then categorised as having excellent, moderate or poor hyperadrenocorticism control, using thresholds produced by 14 independent veterinarians. Correlation co-efficients were used to compare the three cortisol concentrations to the owner score and the Kruskal Wallis and Mann-Whitney U tests were used to compare the three cortisol concentrations between categories of control. Cortisol cut-off values between significantly different categories were determined using ROC curves. Pre-trilostane and 3-hour post-trilostane cortisol were better correlated to the owner score and had cut-offs to differentiate between categories of control that had superior sensitivity and specificity results, than the post-ACTH cortisol. Iatrogenic hypoadrenocorticism was not detected in any unwell dog. This study shows that the pre-trilostane and 3-hour post-trilostane cortisol are potentially better monitoring methods than the ACTH stimulation test

Quantitative analysis of antimicrobial use on British dairy farms

Antimicrobial resistance has been reported to represent a growing threat to both human and animal health, and concerns have been raised around levels of antimicrobial usage (AMU) within the livestock industry. To provide a benchmark for dairy cattle AMU and identify factors associated with high AMU, data from a convenience sample of 358 dairy farms were analysed using both mass-based and dose-based metrics following standard methodologies proposed by the European Surveillance of Veterinary Antimicrobial Consumption project. Metrics calculated were mass (mg) of antimicrobial active ingredient per population correction unit (mg/PCU), defined daily doses (DDDvet) and defined course doses (DCDvet). AMU on dairy farms ranged from 0.36 to 97.79 mg/PCU, with a median and mean of 15.97 and 20.62 mg/PCU, respectively. Dose-based analysis ranged from 0.05 to 20.29 DDDvet, with a median and mean of 4.03 and 4.60 DDDvet, respectively. Multivariable analysis highlighted that usage of antibiotics via oral and footbath routes increased the odds of a farm being in the top quartile (>27.9 mg/PCU) of antimicrobial users. While dairy cattle farm AMU appeared to be lower than UK livestock average, there were a selection of outlying farms with extremely high AMU, with the top 25 per cent of farms contributing greater than 50 per cent of AMU by mass. Identification of these high use farms may enable targeted AMU reduction strategies and facilitate a significant reduction in overall dairy cattle AMU

Erlotinib inhibits osteolytic bone invasion of human non-small-cell lung cancer cell line NCI-H292

Previous preclinical and clinical findings have suggested a potential role of epidermal growth factor receptor (EGFR) in osteoclast differentiation and the pathogenesis of bone metastasis in cancer. In this study, we investigated the effect of erlotinib, an orally active EGFR tyrosine kinase inhibitor (TKI), on the bone invasion of human non-small-cell lung cancer (NSCLC) cell line NCI-H292. First, we established a novel osteolytic bone invasion model of NCI-H292 cells which was made by inoculating cancer cells into the tibia of scid mice. In this model, NCI-H292 cells markedly activated osteoclasts in tibia, which resulted in osteolytic bone destruction. Erlotinib treatment suppressed osteoclast activation to the basal level through suppressing receptor activator of NF-κB ligand (RANKL) expression in osteoblast/stromal cell at the bone metastatic sites, which leads to inhibition of osteolytic bone destruction caused by NCI-H292 cells. Erlotinib inhibited the proliferation of NCI-H292 cells in in vitro. Erlotinib suppressed the production of osteolytic factors, such as parathyroid hormone-related protein (PTHrP), IL-8, IL-11 and vascular endothelial growth factor (VEGF) in NCI-H292 cells. Furthermore, erlotinib also inhibited osteoblast/stromal cell proliferation in vitro and the development of osteoclasts induced by RANKL in vitro. In conclusion, erlotinib inhibits tumor-induced osteolytic invasion in bone metastasis by suppressing osteoclast activation through inhibiting tumor growth at the bone metastatic sites, osteolytic factor production in tumor cells, osteoblast/stromal cell proliferation and osteoclast differentiation from mouse bone marrow cells

Antimicrobial use in food-producing animals:a rapid evidence assessment of stakeholder practices and beliefs

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Food-producing animals throughout the world are likely to be exposed to antimicrobial (AM) treatment. The crossover in AM use between human and veterinary medicine raises concerns that antimicrobial resistance (AMR) may spread from food-producing animals to humans, driving the need for further understanding of how AMs are used in livestock practice as well as stakeholder beliefs relating to their use. A rapid evidence assessment (REA) was used to collate research on AM use published in peer-reviewed journals between 2000 and 2016. Forty-eight papers were identified and reviewed. The summary of findings highlights a number of issues regarding current knowledge of the use of AMs in food-producing animals and explores the attitudes of interested parties regarding the reduction of AM use in livestock. Variation between and within countries, production types and individual farms demonstrates the complexity of the challenge involved in monitoring and regulating AM use in animal agriculture. Many factors that could influence the prevalence of AMR in livestock are of concern across all sections of the livestock industry. This REA highlights the potential role of farmers and veterinarians and of other advisors, public pressure and legislation to influence change in the use of AMs in livestock.This work was supported by Department for Environment Food & Rural Affairs (Defra) [OD0558