Incremental Development of an Integrated Assessment Method for the Professional Curriculum

Objective. To incrementally create and embed biannual integrated knowledge and skills examinations into final examinations of the pharmacy practice courses offered in the first 3 years of the pharmacy curriculum that would account for 10% of each course’s final course grade.Design. An ad hoc integrated examination committee was formed and tasked with addressing 4 key questions. Integrated examination committees for the first, second, and third years of the curriculum were established and tasked with identifying the most pertinent skills and knowledge-based content from each required course in the curriculum, developing measurable objectives addressing the pertinent content, and creating or revising multiple-choice and performance-based questions derived from integrated examination objectives. An Integrated Examination Review Committee evaluated all test questions, objectives, and student performance on each question, and revised the objectives and questions as needed for the following year’s iteration. Eight performance objectives for the examinations were measured.Assessment. All 8 performance objectives were achieved. Sixty-four percent of the college’s faculty members participated in the integrated examination process, improving the quality of the examination. The incremental development and implementation of the examinations over a 3-year period minimized the burden on faculty time while engaging them in the process. Student understanding of expectations for knowledge and skill retention in the curriculum also improved.Conclusions. Development of biannual integrated examinations in the first 3 years of the classroom curriculum enhanced the college’s culture of assessment and addressed accreditation guidelines for formative and summative assessment of students’ knowledge and skills. The course will continue to be refined each year.     

The practitioner as policy analyst: a study of student reflections of an interprofessional course in higher education

Health and welfare practitioners in the United Kingdom have experienced and continue to experience considerable turbulence as services and occupational boundaries undergo restructuring. To a significant extent such turbulence is driven by policies that promote interprofessional agendas. This paper reports on an evaluation of a higher education programme that adopted a social policy approach to the analysis of interprofessional working. The retrospective views were sought of nursing, midwifery, social work and community and youth work post-qualifying students with use of semi-structured questionnaires and focus groups. Although difficulties were encountered with the political science focus to the programme, overall the participants very positively evaluated the opportunity to engage in policy analysis in a shared learning environment. Given the highly politicised, complex and shifting environment of interprofessional working, it is suggested that the study lends support to the argument that 'policy acumen' is a central skill for contemporary health and welfare practitioners. The paper, therefore, starts to explore issues of particular relevance for educationalists involved in developing frameworks for interprofessional programmes particularly in higher education.     

Increasing research capacity and changing the culture of primary care towards reflective inquiring practice: the experience of the West London Research Network (WeLReN)

A number of primary care research networks were set up throughout England in 1998 in order to (1) improve the quality of primary care research (2) increase the research capacity of primary care, and (3) change the culture of primary care towards reflective inquiring practice (NHSE, 2000b). It is not clear how best to operate a network to achieve these diverse aims. This paper describes the first 30 months of a network that adopted a whole system approach in the belief that this would offer the best chance of simultaneously achieving the three aims. A cycle of activity was designed to facilitate the formation of multidisciplinary coalitions of interest for research with complementary 'top down' and 'bottom up' programmes of work co-existing. At least 330 people participated in the generation of research questions of whom one third (33%) were general practitioners, 16% community nurses, 6% practice managers and other primary care practitioners. Over two fifths (43%) were 'key allies' - academics, health authority staff, community workers and project workers. One fifth (110) of all practices (500) in the WeLReN area have collaborated in at least one research project. The ratio of doctor:nurse participation in the 24 research project teams was markedly different in the supported coalitions (2:1) compared to projects devised and led by more experienced researchers (6:1). The evidence suggests that it is possible to operate a primary care research network in a way that develops coalitions of interest from different parts of the health care system as well as both 'top down' and 'bottom up' led projects. It is too early to tell if the approach will be able to achieve its aims in the long-term but the activity data are encouraging. There is a need for more research on the theoretical basis of network operation.     

Intentional ingestion of cyanoacrylate

Abstract

Background. Diphenidine (1-(1,2-diphenylethyl)piperidine) and its 2-methoxylated derivative methoxphenidine (MXP, 2-MeO-diphenidine) are substances with dissociative effects that were recently introduced for “recreational” purpose through the online-based sale of new psychoactive substances (NPS). A number of analytically confirmed non-fatal intoxications associated with diphenidine or MXP have occurred in Sweden and were included in the STRIDA project. Study design. Observational case series of consecutive patients with admitted or suspected intake of NPS and requiring intensive treatment in an emergency room and hospitalization in Sweden. Patients and methods. Blood and urine samples were collected from intoxicated patients presenting at emergency departments all over the country. NPS analysis was performed by multi-component liquid chromatography–mass spectrometry methods. Data on clinical features were collected during telephone consultations with the Poisons Information Centre and retrieved from medical records. Information was also obtained from online drug discussion forums. Case series. Over a 12-month period from January to December 2014, 750 cases of suspected NPS intoxication originating from emergency departments were enrolled in the STRIDA project of which 14 (1.9%) tested positive for diphenidine and 3 (0.4%) tested positive for MXP. Co-exposure to several other NPS (e.g., 5-/6-(2-aminopropyl)benzofuran, 2-4-bromomethcathinone, butylone, 3,4-dichloromethylphenidate, 5-methoxy-N-isopropyltryptamine, methiopropamine, and α-pyrrolidinopentiothiophenone), also including other dissociative substances (3-/4-methoxyphencyclidine), and classical drugs of abuse (e.g., cannabis and ethanol) was documented in 87% of these cases. The 17 patients were aged 20–48 (median: 32) years, and 13 (76%) were men. They commonly presented with hypertension (76%), tachycardia (47%), anxiety (65%), and altered mental status (65%) including confusion, disorientation, dissociation, and/or hallucinations. Eight patients (47%) displayed severe intoxication (Poisoning Severity Score 3). The diphenidine- or MXP-positive patients required hospitalization for 1–3 (median: 2) days. In addition to standard supportive therapy, half of the cases were treated with benzodiazepines and/or propofol. Conclusion. The adverse effects noted in analytically confirmed cases of NPS intoxication involving diphenidine or MXP were similar to those reported for other dissociative substances such as ketamine and methoxetamine. However, the high proportion of polysubstance use might have played a role in the intoxication and clinical features in some cases.     

2010~2014年某大型综合型医院青年科学基金申报资助分析

目的 探讨青年科学基金获资助的必要条件。方法 对2010~2014年某大型综合型医院申请和中标的青年科学基金数据进行统计描述和统计分析,分析基金申请人员和获资助人员基本特征。结果 ①此大型医院近5年共申请青年科学基金543项,中标132项,平均资助率为24.31%;②项目负责人男女性别分布平均,以中级职称居多,重点学科中标率高;③77.27%的科研人员获得青年基金前已经发表过1~3篇SCI论文。结论 科研人员的研究基础对获青年科学基金资助越来越重要。     

Tracking of high- and low-density-lipoprotein cholesterol from childhood to young adulthood in a single large kindred with familial hypercholesterolemia

Tracking of high- and low-density-lipoprotein cholesterol (HDLC, LDLC) from childhood to young adulthood was assessed in 77 children and in 53 adults from a single large pedigree with familial hypercholesterolemia who were respectively less than or equal to 19 and greater than or equal to 20 years old when first studied in 1973, with reassessment in 1984. No children and only five of the adults had received LDLC lowering therapy from 1973 to 1984. The rank correlations between the 1973 and 1984 measurements for LDLC were 0.73, 0.74, and 0.87; and for HDLC were 0.55, 0.73, and 0.65 (P less than 0.0001 for all correlations), respectively for relatives who were less than or equal to 12, 13 to 19, and greater than or equal to 20 years old in 1973. The 1973:1984 LDLC and HDLC correlations, categorized by relationships to the proband, were as follows: (1) unrelated, LDLC = 0.16, HDLC = 0.56;* (2) first-degree relatives, LDLC = 0.90, HDLC = 0.30; (3) second-degree relatives, LDLC = 0.79, HDLC = 0.39; and (4) other relatives, LDLC = 0.62, HDLC = 0.64. All nine of the probands' first-degree relatives who were above the age-sex specific LDLC 95th percentile in 1973 were also greater than the 95th percentile for LDLC in 1984. Similarly, seven of eight second-degree relatives with LDLC greater than the 95th percentile in 1973 were greater than the 95th percentile in 1984, as were ten of 15 other relatives. LDLC levels in childhood in this extended kindred were highly predictive of adult values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Compositional and metabolic heterogeneity of alpha 2- and beta-very-low-density lipoproteins in subjects with broad beta disease and endogenous hypertriglyceridemia

The catabolism of alpha 2- and beta-very-low-density lipoproteins (VLDL) was studied in normolipidemic and hyperlipidemic subjects to determine whether differences in the catabolism of these subfractions are due to their composition. alpha 2-VLDL (cholesterol/triglyceride ratio, 00.18 +/- 0.06; and apoprotein E/C ratio, 0.27 +/- 0.22, n = 4) and beta-VLDL (cholesterol/triglyceride ratio, 0.67 +/- 0.13; and apoprotein E/C ratio, 1.05 +/- 0.52, n = 4) were isolated from subjects with broad beta disease, iodinated, and injected in five normolipidemic subjects, six with broad beta disease, and five with endogenous hypertriglyceridemia. VLDL, intermediate (IDL) and low-density lipoprotein (LDL) apoprotein (apo)-B radioactivity (tetramethylurea insoluble) following injection of 125I-labeled alpha 2- and beta-VLDL decayed biphasically in all subjects, and this decay in normolipidemic subjects was more rapid than in subjects with broad beta disease (P = 0.004) or endogenous hypertriglyceridemia (P = 0.004 for alpha 2- and P = 0.010 for beta-VLDL). The residence times, however, for the delipidation chain in alpha 2-VLDL were similar in all the subjects and varied from three to six hours. The decay of radioactivity in beta-VLDL in subjects with broad beta disease was much slower (residence time, 36.9 +/- 24.4 hr, n = 7) than in normolipidemic subjects (residence time, 7.56 +/- 4.6 hr, n = 5) or in subjects with endogenous hypertriglyceridemia (residence time, 10.6 +/- 4.65, n = 4). The residence time for alpha 2-VLDL was longer than for beta-VLDL in all subjects, suggesting that alpha 2-VLDL is a precursor to beta-VLDL. To test this directly, iodinated alpha 2-VLDL was injected into a subject with broad beta disease and the radioactivity in the subfractions was followed. The radioactivity from alpha 2-VLDL was transferred into beta-VLDL supporting, the notion that alpha 2-VLDL generated some beta-VLDL. Nicotinic acid treatment of a subject with broad beta disease accelerated the catabolism of alpha 2- and beta-VLDL without changing the VLDL composition.     

Reduced triglyceride formation from long-chain polyenoic fatty acids in rat hepatocytes

The mechanism for the marked reduction in hepatic triglyceride secretion when rats are fed fish oils was explored in studies with isolated rat hepatocytes. Hepatocytes obtained from Sprague-Dawley rats fed either chow or fish oil or safflower oil were incubated in the presence of [3H]-glycerol to estimate triglyceride formation. In some experiments, various fatty acids, complexed to albumin, were added to the incubations. Similar experiments were carried out with hepatocytes from a genetic strain of hypertriglyceridemic, obese rats. In the absence of added fatty acid, hepatocytes from fish oil-fed rats produced and secreted substantially less triglyceride than cells from safflower oil-fed rats. However, the addition of 2 mmol/L Na oleate stimulated triglyceride formation similarly in both types of hepatocytes. When hepatocytes from chow fed rats were incubated with fatty acids of increasing chain length and unsaturation (oleate, linolenate, arachidonate, eicosapentaenoate, and docosahexaenoate), the latter two, which characterize the fish oil used, almost totally suppressed triglyceride formation. Coincubation with oleate partly reversed this effect. Hepatocytes from the hypertriglyceridemic rats synthesized significantly more triglyceride than hepatocytes from normal rats; however triglyceride formation was markedly reduced also in this strain of rat by feeding fish oil or by adding docosahexaenoate to hepatocytes in vitro. These studies confirm previous conclusions with perfused livers from fish oil-fed rats that showed diminished triglyceride production and secretion. These findings suggest that diversion of polyenoic acids from pathways of esterification is a major factor in the triglyceride lowering effect of fish oils.(ABSTRACT TRUNCATED AT 250 WORDS)