For health care providers to fully contribute to interprofessional teams, training should be embedded within health care education curriculum. Yet barriers may hinder successful interprofessional education. Determine if learner attitudes toward IPE change over time and with clinical experience. Nebraska Interprofessional Attitudes Scale (NIPEAS) administered prior to student orientation IPE (baseline) and after year 2 IPE events. Repeated-measures analysis of variance (ANOVA) was used to assess change over time for the sample, and mixed method ANOVA to determine if change differed by college. 175 students (five colleges) completed baseline and follow-up surveys. Aggregate NIPEAS scores were significantly higher on follow-up (p < 0.001). Repeated measures t-tests examining change by college revealed that scores increased significantly in Colleges of Medicine (p < 0.001), Allied Health (p = 0.04), and Pharmacy (p = 0.005). Results indicated improved attitudes about IPE differing from previous studies; perhaps the result of NIPEAS design for use in longitudinal studies.

Interprofessional education (IPE) has become increasingly the object of focus in undergraduate medical education. Evidence supports the promotion of teamwork and effective communication to improve patient safety and outcomes. Educators are challenged to find meaningful ways to teach these skills to students and there are several barriers that must be addressed to meet this challenge. Educators must work outside of well-established silos within the medical education community to bring learners from various disciplines together. In addition, they must create curriculum that engages all participants and is relevant to the modern learner. Simulation creates a safe, low stress environment in which participants may practice communication and teamwork without risk to themselves or, more importantly, patients. By practicing a high stress, high stakes scenario in the low risk environment of the simulator, learners from various disciplines are able practice these skills in a meaningful way. Cardiac arrest is an example of a common, high impact occurrence that is particularly amenable to interprofessional team based simulation training exercises. We describe the development of an interprofessional student course teaching communication and teamwork culminating in a team run cardiac arrest simulation exercise. This course was designed to use a blended learning model utilizing both pre-course online materials available to participants, a team training exercise utilizing high-fidelity simulation and team debrief with formative assessment. This blended model addressed the challenge of coordinating multiple learners from multiple colleges and schedules.

Interprofessional education (IPE) for health professions students can facilitate collaboration. Previous instruments to measure student attitudes about IPE were reported to lack psychometric and validity evidence. The Nebraska Interprofessional Education Attitude Scale (NIPEAS) was developed to measure the attitudes of pre-clinical learners to practicing health professionals. The 19 item questionnaire was administered in 2012 to 370 students, in 2013 to 280 faculty, and in 2015 to 353 students. An exploratory factor analysis found that NIPEAS items loaded onto four factors: “Team approach to health care,” “Receptivity to teammates,” “Self-efficacy as a team member” and “Ethics in health care.” Confirmatory factor analysis suggested that the four-factor model for NIPEAS provided an adequate fit to the data. The attitude scales in NIPEAS were derived from the IPEC competencies. NIPEAS appears to be useful for measuring attitudes about interprofessional collaboration of pre-service health professions students and health care providers.

Interprofessional education (IPE) is imperative when training health professions students to practice in an environment requiring a team based approach. IPE has not been widely practiced in the United States (US) since its immergence in the 1970’s and waning in the 1980’s.Contemporary curricula, instruction, and IPE activities still need to be tested. This report focuses on the analysis of qualitative feedback collected from faculty and students participating in IPE activities, designed for first year health professions students in the Fall 2010 (n=542), and Fall 2011 (n=555). An interprofessional research team conducted analysis using an immersion/crystallization framework. Eight major themes emerged from comments provided through evaluations of the IPE activities. Students expressed a desire to learn more about roles, skills, and responsibilities of other professions and wanted additional IPE opportunities integrated throughout their education. Skill level of small IPE group facilitators emerged as an important component for successful IPE activities. Lessons learned through this analysis will guide future augmentation of interprofessional activities locally and can be applied at other medical campuses.

Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical practice. A majority of respondents reported taking some aggressive measures to ration existing supplies. Most premature infants and many infants with congenital anomalies are dependent on parenteral nutrition for the first weeks of life to meet nutritional needs. Because of fragile health and poor reserves, they are uniquely susceptible to this problem. It should be understood that shortages and rationing have been associated with adverse outcomes, such as lactic acidosis and Wernicke encephalopathy from thiamine deficiency or pulmonary and skeletal development concerns related to inadequate stores of Vitamin A and D. In this review, we will discuss the current parenteral shortages and the possible impact on a population of very low birth weight infants. This review will also present a case study of a neonate who was impacted by these current shortages.

Abstract This resource features a series of interprofessional small-group exercises to explore students' perceptions of the other health professions. During this 3-hour session, groups also discuss the meaning of professional behavior and use the insights gained to develop a shared code of ethics. These codes are made available online so that students can compare their own group's results with other groups across campus. This activity can be scaled to include as many students as needed. Previous sessions have included over 450 students participating in 40–45 small groups. This campus-wide event prepares future health professionals for collaborative patient-centered practice by discussing shared values in ethical/professional behavior. It has been included in orientation week for 2 consecutive years. Students and faculty facilitators indicated on a postsurvey that they appreciated the small-group experience. Student indicated that the opportunity for communication and interaction with other health professions students was essential, rarely done in other forums, and very informative.

Background: Data on immunosuppressant adherence of community-dwelling adult solid-organ transplant recipients (SOTRs) from rural populations in the United States are limited. Therefore, understanding the association of rurality and other factors of immunosuppressant adherence will help providers design and deliver patient-centered adherence enhancing interventions.Objectives: The objective was to examine factors associated with a previously validated 4-item Immunosuppressant Therapy Adherence Scale (ITAS) score in community-dwelling adult SOTRs who received a transplant from an academic center in the Midwestern United States.Methods: For this observational study, cross-sectional survey data (patient demographic, medical condition, immunosuppressant therapy, and self-reported ITAS) received from adult SOTRs aged 19 years or older with other data from an academic transplant center's database were merged. Using multivariate logistic regression, significant SOTR characteristics associated with being adherent (ITAS score = 12) versus nonadherent (ITAS score < 12) were examined.Results: The survey response rate was 30% (n = 556/1827). Those SOTRs responding (n = 556) had a kidney (48%), liver (47%), or other (4.5%) transplant. They were more likely to be 50- to 64-year olds (52%), men (55%), white (90%), metroresident (59%), with an annual income less than $55,000. The SOTRs were living with a transplant for 6.3 years (median), reported excellent-to-good health status (77%), and received different immunosuppressant regimens. More than half of the SOTRs (58%) were adherent. In multivariate analyses, compared with patients aged 65 years or older, younger patients, nonmetro rural-versus metroresident, and those having more (>= 6) versus less ( <6) comorbidities were significantly less likely to report adherence. SOTRs receiving tacrolimus-based combination immunosuppressant versus tacrolimus alone were more likely to report adherence.Conclusions: When designing and delivering patient care-centered interventions including those that use technology to increase immunosuppressant adherence, providers need to consider rural residence besides other well-established patient factors (younger age, immunosuppressant drug, and comorbidities) of nonadherence. (C) 2012 Elsevier Inc. All rights reserved.

OBJECTIVES:The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration.METHODS:Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning.RESULTS:Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience.CONCLUSION:This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.

The use of mycophenolate mofetil (MMF), in combination with cyclosporine (CsA) or tacrolimus (FK) and corticosteroids, has been shown to improve clinical outcomes through significant reduction in the incidence of acute rejection in solid organ transplant patients. A fixed oral dosing regimen of 1 or 1.5 g MMF twice daily received Food and Drug Administration approval in 1995 with no recommendations for concentration monitoring at that time. Subsequent evidence has generated substantial debate on the need of clinical monitoring for MMF. This article summarizes the rationale, evidence, and approaches of clinical monitoring for MMF. Mycophenolic acid (MPA), the active moiety of MMF, noncompetitively inhibits the enzyme inosine monophosphate dehydrogenase (IMPDH), which is the target enzyme for MPA. Pharmacokinetic monitoring, by use of MPA predose or MPA area under the concentration-time curve (AUC) values, and pharmacodynamic monitoring by analysis of inhibition of IMPDH have been evaluated in organ transplant patients. The possibility of drug interactions between other immunosuppressive agents has also received attention recently. The clinical implications of drug interactions are discussed in this article.

OBJECTIVE: To characterize the pharmacodynamics and pharmacokinetics of omeprazole suspension in critically ill pediatric liver/intestinal transplant patients. DESIGN: Open-label pharmacodynamic and pharmacokinetic study. SETTING: Pediatric intensive care unit of an academic medical center. PATIENTS: Eleven pediatric liver and/or intestinal transplant patients. INTERVENTIONS: Extemporaneously prepared 0.5 mg/kg omeprazole suspension every 12 hrs via nasogastric tube before sequential measurements of omeprazole serum concentration and gastric pH monitoring. Gastric pH was monitored continuously for 48 hrs and plasma omeprazole concentrations were determined upon first and multiple dosing. MEASUREMENTS AND MAIN RESULTS: Mean onset of action of omeprazole in a sodium bicarbonate vehicle was 62 +/- 82 mins (range, 2-226 mins). Subjects <4 yrs of age exhibited a more variable onset of omeprazole action (range, 3-226 mins) when compared with older subjects (onset of action, 2-40 min). Omeprazole maximum concentration and area under the concentration-time curve for the dosage interval were significantly greater upon multiple dosing when compared with the first dose. Mean baseline gastric pH in this study population was 1.0 +/- 0.8. Gastric pH remained >4.0 for 78.8% +/- 18.9% of the first dosage interval and 97.8% +/- 5.4% of multiple dosage intervals regardless of age when administered twice daily as a suspension. CONCLUSION: These results support the use of omeprazole administered twice daily as a suspension to maintain gastric pH of >4.0 and to achieve maximal pharmacodynamic effect in pediatric liver and/or intestinal transplant patients.

Society of Critical Care Medicine; 28th Educational and Scientific Symposium; San Francisco, California, USA; January 23-27, 1999: Poster Presentations: Poster Hall

SNAEFER, MARKS; COLLIER, DEAN S.; HAVEN, MARY C.; LANGNAS, ALAN N.; STRATTA, ROBERT J.; DONOVAN, JEREMIAH P.; SORRELL, MICHAEL F.; SHAW, BYERS W. JR. Author Information