Stakeholders' perception of the desired Master's program for Kenya in community health nursing: Areas of competency*

Introduction: After the World Health Assembly approved the WHA 45.5 in 1992, which addressed the nursing shortage by refocusing nurses and midwives to meet community health needs, community demands for educated nurses and the needs of higher nursing education in developing countries increased. However, in developing countries that suffering from multiple resource deficiencies, such as Kenya, the strategic direction of higher education in nursing was unclear. Therefore, in Kenya, a major university school of nursing initiated a collaborative study with a well‐established Japanese nursing college to determine the service‐providers' perspective about upgrading the Master's community nursing curriculum. Purpose: The aim of the study was to describe the Kenyan stakeholders' perspective and the expected roles and abilities of Master's graduates in community nursing. Methods: This qualitative, cross‐sectional study used convenience sampling to obtain 21 participants. The content analysis of the data was based on 19 semistructured interviews. Results: Sixteen categories and 42 subcategories were derived from the five key questions that related to the expectations of the Master's program. The Master's graduates were expected to acquire knowledge and skills relating to administration, management, epidemiology, research, and education. The participants recognized that epidemiology, important for preventive care, was minimal among the current community health nurses. Also, Master's graduates must be prepared to manage health programs. Conclusion: The stakeholders expected that Master's graduates would become leaders in community health nursing, with a broad range of knowledge and skills, most notably in the areas of management and administration, epidemiology, and research. Those abilities should be reflected in the curriculum content.     

Pathogenic anti-DNA idiotype (16/6 Id) in systemic lupus erythematosus

Summary Systemic lupus erythematosus (SLE) is regarded as a classical autoimmune disease. Despite this belief, no one has been able to induce the disease in naive animals, neither with DNA nor with anti-DNA antibodies. We report on the induction of SLE in BALB/c mice following immunization with a pathogenic anti-DNA idiotype (16/6 Id) or its anti-Id. We also report on a specific treatment with T suppressor cells specific for the 16/6 Id. The induction of SLE in naive mice with a pathogenic anti-DNA Id suggests an additional mechanism for the diversity of manifestations in this disease.     

Curricular framework: core competencies in multicultural geriatric care

Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework. The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.     

Can a web-based curriculum improve students’ knowledge of,and attitudes about,the interpreted medical interview?

OBJECTIVES: To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD: Six hundred and forty first year medical students over 4 consecutive years took this curriculum as part of their Patient Physician and Society course. They viewed 6 patient-physician-interpreter video vignettes, gave open text analyses of each vignette, and compared their responses to those generated by experts, thereby receiving immediate formative feedback. They listened to video commentaries by a cultural expert, lawyer, and ethicist about working with LEP patients, completed pre- and postmodule questionnaires, which tested relevant knowledge and attitudes, and were provided a summative assessment at the end of the module. Students completed an optional survey assessing the educational value of, and providing open text commentary about, the module. RESULTS: Seventy-one percent (n=456) of first year students who completed the module consented to have their data included in this evaluation. Mean knowledge (19 items) scores improved (46% pre- to 62% postmodule, P<.001), reflecting improvements in knowledge about best interpreter practices and immigration demographics and legal issues. Mean scores on 4 of 5 attitude items improved, reflecting attitudes more consistent with culturally sensitive care of LEP patients. Mean satisfaction with the educational value of the module for 155 students who completed the postmodule survey was 2.9 on a scale of 1 to 4. CONCLUSION: Our web-curriculum resulted in short-term improvement in the knowledge and attitudes necessary to interact with LEP patients and interpreters. The interactive format allowed students to receive immediate formative feedback and be cognizant of the challenges and effective strategies in language discordant medical encounters. This is important because studies suggest that the use of these skills in patient encounters leads to greater patient and provider satisfaction and improved health outcomes.     

Submucosal injection of dexamethasone reduces postoperative discomfort after third-molar extraction: A systematic review and meta-analysis

Background

The authors conducted a systematic review and meta-analysis on the effect of dexamethasone (DX) on edema, trismus, and pain during early and late postoperative periods after third-molar (M3) extraction.

Educating medical students in oral health care: current curriculum and future needs of institutions in Malaysia and Australia

Poor oral health has been associated with compromised general health and quality of life. To promote comprehensive patient management, the role of medical professionals in oral health maintenance is compelling, thus indicating the need for educational preparation in this area of practice. This study aimed to determine the extent of training in oral health in Malaysian and Australian medical schools. An audio‐recorded semi‐structured phone interview involving Academic Programme Directors in Malaysian (n = 9, response rate=81.8%) and Australian (n = 7, response rate = 35.0%) medical schools was conducted during the 2014/2015 and 2014 academic years, respectively. Qualitative data was analysed via thematic analysis, involving coding and grouping into emerging themes. Quantitative data were measured for frequencies. It was found that medical schools in Malaysia and Australia offered limited teaching of various oral health‐related components that were mostly integrated throughout the curriculum, in the absence of structured learning objectives, teaching methodologies and assessment approaches. Barriers to providing oral health education included having insufficient expertise and overloaded curriculum. As medical educators demonstrated support for oral health education, collaboration amongst various stakeholders is integral to developing a well‐structured curriculum and practice guidelines on oral health management involving medical professionals.     

TGF‐β regulation of encephalitogenic and regulatory T cells in multiple sclerosis

Transforming growth factor beta (TGF‐β) is a pleiotropic cytokine that has been shown to influence the differentiation and function of T cells. The role that TGF‐β plays in immune‐mediated disease, such as multiple sclerosis (MS), has become a major area of investigation since CD4⁺ T cells appear to be a major mediator of autoimmunity. This review provides an analysis of the literature on the role that TGF‐β plays in the generation and regulation of encephalitogenic and regulatory T cells (Treg) in experimental autoimmune encephalomyelitis (EAE), an animal model of MS, as well as in T cells of MS patients. Since TGF‐β plays a major role in the development and function of both CD4⁺ effector and Treg, which are defective in MS patients, recent studies have found potential mechanisms to explain the basis for these T‐cell defects to establish a foundation for potentially modulating TGF‐β signaling to restore normal T‐cell function in MS patients.     

糖尿病通过炎症反应加重大鼠脑缺血再灌注损伤

目的：探讨肿瘤坏死因子-α（tumornecrosisfactor-α,TNF-α）和核因子-κB（nuclear factor-κB, NF-κB）在糖尿病大鼠缺血再灌注损伤中的作用。方法36只健康雄性Sprague-Daw ley大鼠按随机数字表法分为正常血糖假手术组、正常血糖脑缺血再灌注组和糖尿病脑缺血再灌注组,每组12只。采用腹腔注射链脲佐菌素制作大鼠糖尿病模型,然后应用栓线法建立局灶性脑缺血再灌注模型,再灌注24 h行神经功能缺损评分,然后2,3,5-氯化二苯四氮唑染色检测脑梗死面积,蛋白质印迹法检测缺血侧皮质NF-κB和TNF-α表达水平。结果正常血糖假手术组、正常血糖脑缺血再灌注组和糖尿病脑缺血再灌注组神经功能评分分别为（0.00±0.00）分、（2.50±1.08）分和（3.20±1.03）分,差异有统计学意义（F=38.015,P<0.001）,且糖尿病脑缺血再灌注组神经功能缺损评分较正常血糖脑缺血再灌注组显著性加重（ P<0.05）。正常血糖假手术组、正常血糖脑缺血再灌注组和糖尿病脑缺血再灌注组梗死面积分别为（0.00±0.00）％、（33.09±5.17）％和（55.45±9.29）％,各组间差异有统计学意义（F=206.614,P<0.001）,其中糖尿病脑缺血再灌注组梗死面积较正常血糖脑缺血再灌注组显著性增大（P<0.05）。再灌注后24 h,各组缺血侧皮质NF-κB（F=29.993,P<0.001）和TNF-α（F=28.722,P<0.001）表达水平差异有统计学意义,其中糖尿病脑缺血再灌注组NF-κB和TNF-α表达水平较正常血糖脑缺血再灌注组显著性增高（P均<0.05）。结论糖尿病会加重脑缺血再灌注损伤,TNF-α和NF-κB表达上调可能是糖尿病加重脑缺血再灌注损伤的机制之一。