Development and pilot testing of the collaborative practice assessment tool

Collaborative practice is receiving increased attention as a model of healthcare delivery that positively influences the effectiveness and efficiency of patient care while improving the work environment of healthcare providers. The collaborative practice assessment tool (CPAT) was developed from the literature to enable interprofessional teams to assess their collaborative practice. The CPAT survey included 56 items across nine domains including: mission and goals; relationships; leadership; role responsibilities and autonomy; communication; decision-making and conflict management; community linkages and coordination; perceived effectiveness and patient involvement; in addition to three open-ended questions. The tool was developed for use in a variety of settings involving a diversity of healthcare providers with the aim of helping teams to identify professional development needs and corresponding educational interventions. The results of two pilot tests indicated that the CPAT is a valid and reliable tool for assessing levels of collaborative practice within teams. This article describes the development of the tool, the pilot testing and validation process, as well as limitations of the tool.     

A passage to interprofessional learning: the benefits to students from an educational visit to India

An educational visit was made by a group of students representing all eight professional pathways on an interprofessional learning programme in health and social care at Canterbury Christ Church University to a hospital in Kerala, India. Interprofessional clinical supervision groups were organised in order to support the students, many of whom had little experience of foreign travel, in an environment they were anticipated to find emotionally challenging. At the close of the visit, following informal observation of a degree of interprofessional learning that had not been anticipated, qualitative data were collected by means of an opportunistically administered questionnaire that yielded insights into the quality of the learning – cultural, interprofessional and personal – that had resulted. This data indicated multiple benefits, some quite unexpected, for all involved; the aim of this paper is to present and discuss these. There are significant implications for health and social care education, including the value of international visits and interprofessional clinical supervision.     

Inhibition of dynamin by dynole 34-2 induces cell death following cytokinesis failure in cancer cells

Inhibitors of mitotic proteins such as Aurora kinase and polo-like kinase have shown promise in preclinical or early clinical development for cancer treatment. We have reported that the MiTMAB class of dynamin small molecule inhibitors are new antimitotic agents with a novel mechanism of action, blocking cytokinesis. Here, we examined 5 of the most potent of a new series of dynamin GTPase inhibitors called dynoles. They all induced cytokinesis failure at the point of abscission, consistent with inhibition of dynamin while not affecting other cell cycle stages. All 5 dynoles inhibited cell proliferation (MTT and colony formation assays) in 11 cancer cell lines. The most potent GTPase inhibitor, dynole 34-2, also induced apoptosis, as revealed by cell blebbing, DNA fragmentation, and PARP cleavage. Cell death was induced specifically following cytokinesis failure, suggesting that dynole 34-2 selectively targets dividing cells. Dividing HeLa cells were more sensitive to the antiproliferative properties of all 5 dynoles compared with nondividing cells, and nontumorigenic fibroblasts were less sensitive to cell death induced by dynole 34-2. Thus, the dynoles are a second class of dynamin GTPase inhibitors, with dynole 34-2 as the lead compound, that are novel antimitotic compounds acting specifically at the abscission stage.     

Operational conditions: legal capacity of a patient soldier refusing medical treatment

Using a three-dimensional ethical role-specific model, this article considers the dual loyalty conflict between following military orders and professional codes of practice in an operational military environment when a patient soldier refuses life-saving medical treatment and where their legal capacity is questionable. The article suggests that although every competent patient has the right to refuse medical treatment even though they may die as a consequence. Ordinarily, it is unethical to exert any undue influence on a patient to accept medical treatment, in a military operational environment where attack from the enemy is likely, it may be reasonable and understandable to exert undue influence over a patient when they lack legal capacity.     

Pharmacokinetics of Oxymorphone in Titi Monkeys (Callicebus spp.) and Rhesus Macaques (Macaca mulatta)

Oxymorphone is a pure μ-opioid receptor agonist that is commonly used in nonhuman primate medicine and surgery to minimize pain ranging in intensity from moderate to severe. We compared pharmacokinetic profiles and physiologic and behavioral responses to oxymorphone between titi monkeys (Callicebus spp.) and rhesus macaques (Macaca mulatta). Titi monkeys (n = 4) and rhesus macaques (n = 4) were injected intravenously with either a bolus of 0.075 mg/kg oxymorphone or placebo on multiple occasions, with a minimal washout period of 14 d between trials. Blood collection was limited to no more than 3 samples per trial, with samples collected at multiple time points until 10 h after injection. Collection periods, animal order, and testing day were randomized. In addition, macaques underwent a single serial collection at all time points to validate study design. A 2-compartment model best described the disposition of oxymorphone in both species. Clearance was faster in macaques than titi monkeys, in which terminal half-life was longer. Statistically significant physiologic differences were found between species and between treatments within species. Apart from these effects, oxymorphone did not significantly change physiologic parameters over time. After oxymorphone treatment, macaques demonstrated behaviors reflecting pruritis, whereas titi monkeys exhibited sedation. Despite its mild side effects, we recommend the consideration of oxymorphone for pain management protocols in both Old and New World nonhuman primates.Oxymorphone is a semisynthetic opioid analgesic. A highly specific, pure μ-agonist, oxymorphone is 10 times more potent than morphine after intravenous administration.^{7,8,11,21,26,28,29} Historically, oxymorphone has been the analgesic of choice in nonhuman primates and is used to minimize postoperative pain.²⁹ Unlike morphine, oxymorphone does not appear to induce histamine release; and it is believed to minimally effect the respiratory system as compared with other μ-agonists, such as morphine or hydromorphone (dose-dependent effects).^{9,11,26,28,29,31,32}Rhesus macaques (Macaca mulatta) are terrestrial Old World primates that have been used extensively in biomedical research. Adult animals range in weight from 4.5 to more than 12 kg. Existing in large, male-dominated, mixed-sex groups, rhesus macaques are polygamous breeders. Female rhesus establish complex hierarchical class systems and provide primary parental care to infants.⁵ Oxymorphone pharmacokinetic profiles have recently been published for this species.²¹Titi monkeys (Callicebus spp.) are arboreal New World primates that can be found throughout the tropical forests of the Amazon and Orinoco basins. Adult animals range in weight from 0.8 to 1.5 kg. Titi monkeys form monogamous family units comprising a male–female pair bond and any immature offspring. Parental care is provided primarily by the adult male monkey.^{10,14,15,18,23,25,27,36} To date, oxymorphone pharmacokinetic profiles have not been determined for titi monkeys or any other New World monkey.The California National Primate Research Center has maintained a small, captive colony of titi monkeys since 1972.^36,37 These animals have been used for neurobehavioral and psychologic studies.^{4,10,13,23-25,27,36} Other monogamous New World monkeys found in research include marmosets, tamarins, and owl monkeys.^4,5 All of these monkeys belong to the Cebidae family and are comparable in size (0.5 to 1.5 kg). Polygamous squirrel monkeys (Saimiri spp.) belong to the same taxonomic family and share similar dietary habits to titi monkeys. Squirrel monkeys are commonly used in biomedical research.^5,13,27New World monkeys have been reported to be exquisitely sensitive to opioid administration.^5,7,11,29 Therefore, in the current study we recorded various physiologic and behavioral data to compare the responses of titi monkeys to oxymorphone administration with those of rhesus macaques. We sought to evaluate whether the reported anecdotal opioid sensitivity of New World monkeys reflected pharmacokinetic, pharmacodynamic, or perception differences. The purpose of the present study was to characterize the disposition of oxymorphone in New World titi monkeys and compare the associated pharmacokinetic effects with those well characterized for Old World rhesus macaques. We hypothesized that titi monkeys and rhesus macaques would show significant differences with regard to oxymorphone pharmacokinetics. We also hypothesized that physiologic parameters would differ significantly between species and treatments. Finally, we hypothesized that both species would demonstrate similar behaviors after administration of oxymorphone.