Knowledge of the patient as decision‐making power: staff members' perceptions of interprofessional collaboration in challenging situations in psychiatric inpatient care

Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession‐specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision‐making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first‐hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person‐centred care.     

Elevated CD8 T cell responses in type 1 diabetes patients to a 13 amino acid coeliac‐active peptide from α‐gliadin

Some type 1 diabetes (T1D) patients have been reported to exhibit T cell reactivity to wheat gluten. We tested the hypothesis that this T cell reactivity could be abolished by using prolyl‐endopeptidase (PEP), an enzyme that cleaves peptide bonds after proline. Peripheral blood mononuclear cells (PBMCs) were isolated from T1D patients and healthy controls. PBMCs were stimulated with a peptic–tryptic digest of wheat gluten; a peptic–tryptic‐PEP digest of wheat gluten; and a 13 amino acid peptide from wheat gluten. Fluorescent‐labelled antibodies to CD3, CD4 and CD8 cell marker proteins were utilized to determine proliferative responses of CD3, CD4 and CD8 T cells. There were no significant differences in proliferative responses of CD3 or CD4 T cells to the wheat gluten antigens. A significantly higher proportion of CD8⁺ T cells from T1D patients proliferated in the presence of the 13 amino acid peptide than when challenged with the peptic–tryptic or the peptic–tryptic–PEP digests of wheat gluten. PEP treatment had no significant effect on CD8 T cell reactivity to the peptic–trytic digest of wheat gluten. Our results suggest that wheat gluten‐derived peptides, containing ≤ 13 amino acids, may evoke T cell responses in T1D patients.     

Tissue‐Engineered Tracheal Reconstruction Using Three‐Dimensionally Printed Artificial Tracheal Graft: Preliminary Report

Three‐dimensional printing has come into the spotlight in the realm of tissue engineering. We intended to evaluate the plausibility of 3D‐printed (3DP) scaffold coated with mesenchymal stem cells (MSCs) seeded in fibrin for the repair of partial tracheal defects. MSCs from rabbit bone marrow were expanded and cultured. A half‐pipe‐shaped 3DP polycaprolactone scaffold was coated with the MSCs seeded in fibrin. The half‐pipe tracheal graft was implanted on a 10 × 10‐mm artificial tracheal defect in four rabbits. Four and eight weeks after the operation, the reconstructed sites were evaluated bronchoscopically, radiologically, histologically, and functionally. None of the four rabbits showed any sign of respiratory distress. Endoscopic examination and computed tomography showed successful reconstruction of trachea without any collapse or blockage. The replaced tracheas were completely covered with regenerated respiratory mucosa. Histologic analysis showed that the implanted 3DP tracheal grafts were successfully integrated with the adjacent trachea without disruption or granulation tissue formation. Neo‐cartilage formation inside the implanted graft was sufficient to maintain the patency of the reconstructed trachea. Scanning electron microscope examination confirmed the regeneration of the cilia, and beating frequency of regenerated cilia was not different from those of the normal adjacent mucosa. The shape and function of reconstructed trachea using 3DP scaffold coated with MSCs seeded in fibrin were restored successfully without any graft rejection.     

Radiographic evaluation of marginal bone maintenance around tissue level implant and bone level implant: a randomised controlled trial. A 1‐year follow‐up

The etiologic factors associated with crestal bone loss have not been comprehensively clarified. Several theories exist as to the reason for the observed changes in crestal bone height following implant restoration. In the 1990s, the wide‐diameter implants were commercially introduced. Initially, the implants were restored with standard‐diameter abutments because of lack of matching prosthetic components. Long‐term radiographic follow‐up of these ‘platform‐switched’ restored wide‐diameter dental implants has demonstrated a smaller‐than‐expected vertical change in the crestal bone height around these implants that is typically observed around implants restored conventionally with prosthetic components of matching diameters. The aim of this randomised controlled study was to assess radiographically marginal bone level alterations in implants restored according to the platform‐switching concept compared with traditionally restored implants. Fifty‐four subjects to participate in this randomised controlled study were selected. Two groups were assigned at random: control group (56 implants were restored with standard matching‐diameter abutments) and test group (58 implants were restored with medialised abutments). X‐ray explorations were taken for peri‐implant bone level at the minute the last cementing of the prosthesis and at 1‐year follow‐up. NHI Image was used to digitally process and manipulate the radiographic images and perform the measurements. Mean of bone loss with platform‐switching implants was ?0·01 mm, and the mean of bone loss with standard platform implant was 0·42 mm. Outcomes of this study indicated that the platform‐switching design could preserve the crestal bone levels to 1‐year follow‐up. There was a statistically significant difference in marginal bone loss.     

High Prevalence of Subclinical Atherosclerosis by Carotid Ultrasound among Mexican Americans: Discordance with 10‐Year Risk Assessment using the Framingham Risk Score

Background: Framingham risk scores (FRS) were validated in a mostly Caucasian population. Evaluation of subclinical atherosclerosis by carotid ultrasound may improve ascertainment of risk in nonwhite populations. This study aimed to evaluate carotid intima‐media thickness (cIMT) and carotid plaquing among Mexican Americans, and to correlate these markers with coronary risk factors and the FRS. Methods/Results: Participants (n = 141) were drawn from the Cameron County Hispanic Cohort. Carotid artery ultrasound was performed and cIMT measured. Carotid plaque was defined as areas of thickening >50% of the thickness of the surrounding walls. Mean age was 53.1 ± 11.7 years (73.8% female). Most were overweight or obese (88.7%) and more than half (53.2%) had the metabolic syndrome. One third (34.8%) had abnormal carotid ultrasound findings (either cIMT ≥75th percentile for gender and age or presence of plaque). Among those with abnormal carotid ultrasound, the majority were classified as being at low 10‐year risk for cardiovascular events. Carotid ultrasound reclassified nearly a third of the cohort as being at high risk. This discordance between 10‐year FRS and carotid ultrasound was noted whether risk was assessed for hard coronary events or global risk. Concordance between FRS and carotid ultrasound findings was best when long‐term (30‐year) risk was assessed and no subject with an abnormal carotid ultrasound was categorized as low risk by the 30‐year FRS algorithm. Conclusions: Integration of carotid ultrasound findings to coronary risk assessments and use of longer term prediction models may provide better risk assessment in this minority population, with earlier initiation of appropriate therapies.