A mixed-method longitudinal study of an interprofessional education course

The purpose of this mixed-method longitudinal study was to understand how health professional students' perceptions of their professional flexibility, role interdependence, and reflection on their process of working together change over time as a result of participating in an interprofessional education course. Data were collected from students enrolled in an interprofessional service-learning course each year from Fall 2014 to 2018 via online surveys at four assessment points and through qualitative reflection papers that served as course assignments. The 14-week course consisted of both didactic instruction and an experiential component whereby students conducted a service-learning activity in interprofessional teams. Quantitative findings demonstrate that students experienced a significant quadratic growth trajectory in reflection on process and a significant linear growth trajectory in professional flexibility. Students reported experiencing non-significant changes in role interdependence. Qualitative data, however, suggest student learning across all three domains. This study has implications for interprofessional educational initiatives aimed at promoting students' interprofessional competencies.

1950. Intentional Interprofessional Experiential Education in an HIV/Infectious Diseases Clinic

Background

Experiential education opportunities, such as interprofessional practice, are currently limited in HIV care. This intentional interprofessional experiential education (IPEE) offering aimed to improve healthcare student attitudes, perceptions, and skills regarding interprofessional practice and HIV care.

Methods

An interprofessional team of faculty and clinicians designed a 2-week rotation, with each offering consisting of 6–9 students from 4 professions (medicine, nursing, pharmacy, social work). This intentional IPEE was delivered at a single ambulatory care infectious diseases clinic in Columbia, SC. It included time in clinic with providers from varying professions, didactic lectures, a peer health advocate session, and a team capstone project (i.e., simulated, then actual student team visit with an HIV-infected patient, plus note documentation/team presentation). Twelve offerings occurred from October 2016 to February 2019. Anonymous pre- and post-IPEE surveys were provided to each student at baseline and directly after to assess attitudes, perceptions, and skills regarding interprofessional practice and HIV care. Wilcoxon signed-rank tests were used to compare pre- vs. post-survey items. Multivariable logistic regression was used to evaluate predictors for interest in HIV as a specialty.

Results

Of 87 students, 84 (97%) completed both surveys (21 medicine, 25 nursing, 19 pharmacy, 19 social work). Attitudes toward healthcare teams significantly improved in 7/11 items (all P-values ≤ 0.019), teamwork perceptions improved in 5/8 items (P ≤ 0.017), and self-perceived team skills improved in all 6 items (P < 0.001). Students rated provider time in clinic as most valuable (mean 4.6, median 5 on 5-point Likert scale). Following the IPEE, the proportion of students interested in HIV care increased from 53% to 67% (P = 0.07). After adjusting for program year and profession, interest in HIV at baseline was a significant predictor of interest in HIV post-IPEE (aOR 8.2, 95% CI 2.6–25.5).

Conclusion

Short-term, intentional IPEE can positively impact student attitudes, perceptions, and skills regarding interprofessional practice and HIV care. Clinical educators should incorporate intentional HIV IPEE in healthcare curricula.

Disclosures

All Authors: No reported Disclosures.

Sensitizing Future Health Professionals to Determinants of Childhood Obesity

Long-term solutions to the childhood obesity epidemic will require concerted interdisciplinary efforts that are sensitive to both individual and social determinants of health. The Junior Doctors of Health© (JDOH) program involves interprofessional education (IPE) with university students from health science fields (e.g., medicine, pharmacy, social work, public health) who deliver an interactive program in teams to at-risk school-aged youth. The purpose of this study was to assess the impact of participation in the JDOH IPE program on university students' beliefs about childhood obesity. Fifty-three of the 71 health sciences students enrolled in the JDOH IPE program between 2011 and 2013 participated in this study. Pre- and post-surveys assessed students' beliefs about the importance, causes of, and responsibility for reducing childhood obesity with both closed- and open-ended questions. In 2013, quantitative data were analyzed using Wilcoxon matched-pairs signed-rank tests and qualitative data were analyzed through open coding to identify emergent themes. Results indicate that after participation in the JDOH IPE program, students' identification of social and environmental causes of childhood obesity increased significantly. Further, students' ranking of the importance of obesity was initially higher than those of different issues typically portrayed as social or environmental (e.g., youth violence) but it was similarly ranked after participation in JDOH. This suggests a greater sensitivity to social and environmental challenges faced by youth. Findings suggest that IPE experiences that bring clinical and community-oriented health professions together to engage with disadvantaged youth foster sensitivity to the complexities of childhood obesity in low-income settings.

Floral scent composition predicts bee pollination system in five butterfly bush (Buddleja, Scrophulariaceae) species

Traditionally, plant-pollinator interactions have been interpreted as pollination syndrome. However, the validity of pollination syndrome has been widely doubted in modern studies of pollination ecology. The pollination ecology of five Asian Buddleja species, B. asiatica, B. crispa, B. forrestii, B. macrostachya and B. myriantha, in the Sino-Himalayan region in Asia, flowering in different local seasons, with scented inflorescences were investigated during 2011 and 2012. These five species exhibited diverse floral traits, with narrow and long corolla tubes and concealed nectar. According to their floral morphology, larger bees and Lepidoptera were expected to be the major pollinators. However, field observations showed that only larger bees (honeybee/bumblebee) were the primary pollinators, ranging from 77.95% to 97.90% of total visits. In this study, floral scents of each species were also analysed using coupled gas chromatography and mass spectrometry (GC-MS). Although the five Buddleja species emitted differentiated floral scent compositions, our results showed that floral scents of the five species are dominated by substances that can serve as attractive signals to bees, including species-specific scent compounds and principal compounds with larger relative amounts. This suggests that floral scent compositions are closely associated with the principal pollinator assemblages in these five species. Therefore, we conclude that floral scent compositions rather than floral morphology traits should be used to interpret plant-pollinator interactions in these Asian Buddleja species.

Musculoskeletal safety outcomes of patients receiving daptomycin with HMG-CoA reductase inhibitors

Daptomycin, a cyclic lipopeptide antibiotic, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are commonly administered in the inpatient setting and are associated with creatine phosphokinase (CPK) elevations, myalgias, and muscle weakness. Safety data for coadministration of daptomycin with statins are limited. To determine the safety of coadministration of daptomycin with statin therapy, a multicenter, retrospective, observational study was performed at 13 institutions in the Southeastern United States. Forty-nine adult patients receiving statins concurrently with daptomycin were compared with 171 patients receiving daptomycin without statin therapy. Detailed information, including treatment indication and duration, infecting pathogen, baseline and subsequent CPK levels, and presence of myalgias or muscle complaints, was collected. Myalgias were noted in 3/49 (6.1%) patients receiving combination therapy compared with 5/171 (2.9%) of patients receiving daptomycin alone (P = 0.38). CPK elevations of >1,000 U/liter occurred in 5/49 (10.2%) patients receiving combination therapy compared to 9/171 (5.3%) patients receiving daptomycin alone (P = 0.32). Two of five patients experiencing CPK elevations of >1,000 U/liter in the combination group had symptoms of myopathy. Three patients (6.1%) discontinued therapy due to CPK elevations with concurrent myalgias in the combination group versus 6 patients (3.5%) in the daptomycin-alone group (P = 0.42). CPK levels and myalgias reversed upon discontinuation of daptomycin therapy. Overall musculoskeletal toxicity was numerically higher in the combination group but this result was not statistically significant. Further prospective study is warranted in a larger population.

Ticlopidine-, clopidogrel-, and prasugrel-associated thrombotic thrombocytopenic purpura: a 20-year review from the Southern Network on Adverse Reactions (SONAR)

Thienopyridine-derivatives (ticlopidine, clopidogrel, and prasugrel) are the primary antiplatelet agents. Thrombotic thrombocytopenic purpura (TTP) is a rare drug-associated syndrome, with the thienopyridines being the most common drugs implicated in this syndrome. We reviewed 20 years of information on clinical, epidemiologic, and laboratory findings for thienopyridine-associated TTP. Four, 11, and 11 cases of thienopyridine-associated TTP were reported in the first year of marketing of ticlopidine (1989), clopidogrel (1998), and prasugrel (2010), respectively. As of 2011, the FDA received reports of 97 ticlopidine-, 197 clopidogrel-, and 14 prasugrel-associated TTP cases. Severe deficiency of ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) was present in 80% and antibodies to 100% of these TTP patients on ticlopidine, 0% of the patients with clopidogrel-associated TTP (p < 0.05), and an unknown percentage of patients with prasugrel-associated TTP. TTP is associated with use of each of the three thienopyridines, although the mechanistic pathways may differ.

Management of Hypertension in Renal Transplant Patients: A Comprehensive Review of Nonpharmacologic and Pharmacologic Treatment Strategies

Objective:

To review the guidelines and literature for the treatment of hypertension in renal transplant patients and to provide guidance to practitioners in the selection of appropriate nonpharmacologic and pharmacologic treatment options.

Data Sources:

A PubMed search (January 1948–March 2010) was performed using the search terms hypertension, antihypertensive agents, blood pressure, and cardiovascular disease, in combination with renal transplant and kidney transplant. The search was limited to articles published in English. All relevant peer-reviewed original studies, meta-analyses, guidelines, consensus statements, and review articles were examined. In addition, reference citations from publications identified were reviewed.

Study Selection and Data Extraction:

All literature found was evaluated for inclusion. Review articles as well as prospective and retrospective original research articles were reviewed.

Data Synthesis:

Hypertension after solid organ transplantation is a problem commonly encountered in patients during their posttransplantation clinic visits. Effective management of these patients' hypertension is crucial, as hypertension left untreated may lead to increased morbidity and mortality as well as graft loss. The unique, multifactorial etiology of hypertension in this population makes treatment choices more challenging compared to treatment of a nontransplant patient. Therefore, to guide practitioners in this process, we developed a hypertension management protocol, taking into account the unique considerations faced in the adult renal transplant population. The review guides practitioners from the initial assessment of patients' hypertension through the evaluation and selection of nonpharmacologic and pharmacologic treatment options and provides information about the discontinuation of certain antihypertensive medications. It also provides a concise, but comprehensive review of the major antihypertensive drug classes and economic considerations.

Conclusions:

The management of hypertension in posttransplantation patients is challenging and complicated, yet necessary to prevent morbidity, mortality, and graft loss for these patients. Therapy should be individualized based on patient assessment, response to previous therapy, and economic considerations.

Survey of colleges of pharmacy to assess preparation for and promotion of residency training

OBJECTIVE

To assess the prevalence of curricular programs or other structured activities designed to prepare students for and to promote residency training.

METHODS

An electronic survey instrument containing 12 questions regarding institutional demographics and activities related to pharmacy student preparation for residency training was sent to administrators of all US colleges and schools of pharmacy.

RESULTS

Ninety-one survey instruments were e-mailed to US colleges and schools of pharmacy administrators, and an overall response rate of 78% was attained. Twenty-two percent of respondents identified a structured curricular program to prepare students for postgraduate training. In addition, informal programs or informational sessions varying in scope and content were offered by many colleges and schools to prepare students for residency training.

CONCLUSION

Many of the US colleges and schools of pharmacy reported structured activities or programs that promote residency training to students. Ten programs had a designated clinical-track curriculum.

The influence of genotype, sex, and dietary lysine on pork subprimal cut yields and carcass quality of pigs fed to either 104 or 127 kilograms

One hundred twenty pigs (initially 44 kg BW) were used to determine the effects of genotype, sex, and dietary lysine on subprimal cut yields and carcass quality. Within genotype (high or medium potential for lean tissue gain), barrows and gilts were fed separately either a .90 or .70% lysine diet until the mean weight of each pen of three pigs reached 104 kg. Then one pig was removed and dietary lysine for the remaining two pigs was decreased to .75 or .55%, respectively. At both 104 and 127 kg BW, carcasses from high-lean genotype (HLG) pigs and gilts had (P < .01) higher percentages of boneless closely trimmed ham, loin, and shoulder than carcasses from medium-lean genotype (MLG) pigs and barrows, respectively. At 104 kg BW HunterLab values indicated (P < .01) that HLG longissimus muscle (LM) was redder, more yellow, and more intense in color than MLG LM. The LM from HLG gilts had (P < .05) higher Warner-Bratzler shear values (less tender) than LM from HLG barrows and MLG pigs at 104 kg BW. At 127 kg BW, HLG LM was visually firmer (P < .05) and more reddish-pink (P < .01); had HunterLab values (P < .01) that indicated a darker, redder color; had less moisture exudate (P < .05), thaw loss (P < .01), and percentage of lipid (P < .01); and had a higher pH (P < .05) than MLG LM. Barrow LM had more marbling (P < .05), a higher percentage of lipid (P < .01), less moisture exudate (P < .05), and less thaw loss (P < .01) than LM from gilts. The LM from HLG barrows had higher (P < .05) Warner-Bratzler shear values than the LM from HLG gilts and MLG pigs at 127 kg BW. Overall, the dietary regimens used in this trial resulted in minimal differences in either carcass quality or cutability. The production option of feeding HLG gilts to 127 kg can be used to optimize carcass cutability and quality traits.

Morphological Changes as Observed by Light Microscopy of the Acrosome of Boar Spermatozoa Subjected to Deep Freezing

The effects of chilling (5�C) and deep freezing in liquid nitrogen (-196�C) on the acrosomal morphology of diluted boar spermatozoa were evaluated by light microscopy using Giemsa stain. A large reduction in numbers of spermatozoa with normal acrosomes was recorded as the temperature fell from 30 to 5�C but the greatest damage occurred during the freeze-thaw cycle.

Anaesthesia in a delightful setting: Gull Force Medical Aid Project in Ambon

Civil aid projects in developing countries and military experience in South Vietnam have enabled numerous Australian and New Zealand anaesthetists to experience and evaluate anaesthetic techniques, drugs, unfamiliar apparatus and the anaesthetic training of paramedical personnel under unusual conditions. Supply problems, economic conditions, climate, educational standards of trainees, and the health of the community are some of the factors which influence the methods which have been adopted. The value of this experience is seen in its continuing commitment to civil aid projects in developing countries, and parallels are also seen in the anaesthetic requirements for major disasters, whether civil or military.