Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues

Background: In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed. Approach: Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4th-year nursing and 5th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students’ self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education. Outcomes:To understand student’s learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set – largely unspecific – goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process. Reflection: The contrast between students’ aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.</p

Mucopolysaccharidosis type IIIB may predominantly present with an attenuated clinical phenotype

Mucopolysaccharidosis type IIIB (MPS IIIB, Sanfilippo syndrome type B) is a lysosomal storage disorder caused by deficiency of the enzyme N-acetyl-α-D-glucosaminidase (NAGLU). Information on the natural course of MPS IIIB is scarce but much needed in view of emerging therapies. To improve knowledge on the natural course, data on all 52 MPS IIIB patients ever identified by enzymatic studies in the Netherlands were gathered. Clinical data on 44 patients could be retrieved. Only a small number (n = 9; 21%) presented with a classical MPS III phenotype; all other patients showed a much more attenuated course of the disease characterized by a significantly slower regression of intellectual and motor abilities. The majority of patients lived well into adulthood. First signs of the disease, usually mild developmental delay, were observed at a median age of 4 years. Subsequently, patients showed a slowing and eventually a stagnation of development. Patients with the attenuated phenotype had a stable intellectual disability for many years. Molecular analysis was performed in 24 index patients. The missense changes p.R643C, p.S612G, p.E634K, and p.L497V were exclusively found in patients with the attenuated phenotype. MPS IIIB comprises a remarkably wide spectrum of disease severity, and an unselected cohort including all Dutch patients showed a large proportion (79%) with an attenuated phenotype. MPS IIIB must be considered in patients with a developmental delay, even in the absence of a progressive decline in intellectual abilities. A key feature, necessitating metabolic studies, is the coexistence of behavioral problems

Leiderschap komt niet vanzelf: Over het ontwikkelen van leiderschap van leraren dat impact heeft

Marco Snoek beschouwt leraren als sleutelfiguren in processen van verandering en ontwikkeling. Hun vermogen om richting te geven aan en invloed uit te oefenen op veranderingen op de eigen school en op hun collega’s noemt hij ‘leiderschap van leraren’. Het tijdschrift Van Twaalf tot Achttien sprak met hem

Integer handelen… een dilemma!

In dit artikel wordt bepleit medewerkers actief te betrekken bij integriteitsvraagstukken door te discusseren over ethische dilemma’s binnen de eigen organisatie. Negen veelvuldig voorkomende dilemma’s worden gepresenteerd. Aan de hand van een dilemma van een financieel controller die door haar leidinggevende wordt gevraagd financiële cijfers aan te passen, bespreken we het beslissingsmodel van Rest, dat inzage geeft in individuele processen bij het maken van integere keuzes. Uit ons onderzoek blijkt dat de manier waarop individuen met dilemma’s omgaan zeer uiteenlopend is wat kan leiden tot verschillende uitkomsten in hetzelfde dilemma. Het artikel eindigt met de toepassingen van ethische dilemma’s

Assessment of TGF-β1-mediated growth inhibition of HPV-16- and HPV-18-transfected foreskin keratinocytes during and following immortalization

The responsiveness to transforming growth factor-β1 (TGF-β1) of two human keratinocyte cell lineages (FK16A and FK18B) generated after transfection with HPV-16 and HPV-18, respectively, was investigated. Both cell lineages revealed loss of heterozygosity (LOH) at 18q and/or 3p associated with the acquisition of the immortal phenotype. These loci harbour genes (TGF-β receptor II gene at 3p, and Smad2 and Smad4 genes at 18q) encoding products involved in the TGF-β1 signalling pathway. Mortal and early immortal stages of both cell lineages displayed growth reduction upon exposure to TGF-β1 concentrations in the range 100 pg/ml to 1 ng/ml. However, the late immortal stages were resistant to TGF-β1 at concentrations up to 10 ng/ml. TGF-β1 receptors type I and II were expressed at all stages in both cell lineages. Moreover, mRNA levels of Smad2 and Smad4 genes were nearly constant throughout. TGF-β1 expression and secretion, which were demonstrated in all analysed stages, may provide selective conditions underlying unresponsiveness to TGF-β1 upon prolonged monolayer culturing. Thus, LOH at 3p and/or 18q seen during HPV-mediated immortalization of human keratinocytes was not associated with resistance to TGF-β1-mediated growth inhibition or a marked reduction in TGF- β1 receptors and mRNA levels of Smad2 or Smad4. Therefore, alternative events are likely to underlie unresponsiveness to TGF- β1 in late-passage FK16A and FK18B cells