Effectiveness of interprofessional education in renal physiology curricula for health sciences graduate students.

The primary purpose of conducting an interprofessional education (IPE) experience during the renal physiology block of a graduate-level course was to provide basic science, physical therapy, and physician assistant graduate students with an opportunity to work as a team in the diagnosis, treatment, and collaborative care of a patient with acute kidney injury. The secondary purpose was to enhance the understanding of basic renal physiology principles with a patient case presentation of renal pathophysiology. The overall purpose was to assess the value of IPE integration within a basic science course by examining student perceptions and program evaluation. Graduate-level students operated in interprofessional teams while working through an acute kidney injury patient case. The following Interprofessional Education Collaborative subcompetencies were targeted: Roles/Responsibilities (RR) Behavioral Expectations (RR1, RR4) and Interprofessional Communication (CC) Behavioral Expectations (CC4). Clinical and IPE stimulus questions were discussed both within and between teams with assistance provided by faculty facilitators. Students were given a pre- and postsurvey to determine their knowledge of IPE. There were statistically significant increases from pre- to postsurvey scores for all six IPE questions for all students. Physical therapy and physician assistant students had a statistically significant increase in pre- to postsurvey scores, indicating a more favorable perception of their interprofessional competence for RR1, RR4, and CC4. No changes were noted in pre- to postsurvey scores for basic science graduate students. Incorporating planned IPE experiences into multidisciplinary health science courses represents an appropriate venue to have students learn and apply interprofessional competencies.

Six minute walk test in people with tuberculosis sequelae.

BACKGROUND & PURPOSE: Tuberculosis is an infectious disease that affects the lungs and results in poor lung compliance secondary to diffuse fibrotic changes to lung tissue. Consequently, people with pulmonary tuberculosis experience impaired gas exchange resulting in a decline in functional capacity. The purpose of this study was to evaluate the physical functional capacity (VO(2)max) in a group of older (50 - 65 years) people with pulmonary tuberculosis and to compare them to an age-matched healthy group. A secondary purpose was to develop reference equations that could be used to predict 6 minute walk test (6MWT) distance in older, healthy people in India. METHODS: Sixty healthy subjects (30 male and 30 female) and 60 subjects with a diagnosis of pulmonary tuberculosis (30 male and 30 female) participated in the study. All subjects underwent a 6MWT. Walk-work was calculated and used for evaluating functional capacity. Group comparison for functional capacity was done using 2-tailed t-tests. Pearson product correlation was used to examine for significant relationships and regression analysis was used to derive reference equations. RESULTS: There was a significant difference between groups in regard to functional capacity and 6MWT distance (p < 0.001). Reference equations were developed that use age, height, and weight as predictors for 6MWT distance in the healthy group. CONCLUSION: The sequelae from pulmonary tuberculosis have considerable impact on functional capacity in older people in India.

Concurrent validity and reliability of the Alberta Infant Motor Scale in infants at dual risk for motor delays.

Concurrent validity of scores for the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Gross Motor Scale-2 (PDGMS-2) was examined with a sample of 35 infants at dual risk for motor delays or disabilities. Dual risk was defined as low birthweight ( 9 months of age. Novice examiners' scores on both measures closely approximated those of experienced examiners (ICC range = .98 to .99). The results support concurrent validity of the AIMS and PDGMS-2 for infants at dual risk and have implications for using the AIMS in high-risk follow-up programs, particularly in relation to evaluating functional components of motor performance and ease of administration.

Consequences of alcohol-induced early dysregulation of responses to trauma/hemorrhage.

Acute alcohol intoxication is a frequent underlying condition associated with traumatic injury. Studies from our laboratory have been designed to examine the early hemodynamic, proinflammatory, and neuroendocrine alterations in responses to hemorrhagic shock in surgically catheterized, conscious, unrestrained, male Sprague-Dawley rats during acute alcohol intoxication (1.75-g/kg bolus, followed by a constant 15-h infusion at a rate of 250-300 mg/kg/h). With both fixed-pressure (40 mm Hg) and fixed-volume (50%) hemorrhagic shock, followed by fluid resuscitation with Ringer's lactate, acute (15 h) alcohol intoxication has been shown to impair significantly the immediate hemodynamic, metabolic, and inflammatory counterregulatory responses to hemorrhagic shock. Alcohol intoxication enhanced hemodynamic instability during blood loss and impaired the recovery of mean arterial blood pressure during fluid resuscitation. Activation of neuroendocrine pathways involved in restoring hemodynamic stability was significantly attenuated in alcohol-intoxicated hemorrhaged animals. The hemodynamic and neuroendocrine impairment is associated with enhanced expression of lung and spleen tumor necrosis factor, and it suppressed circulating neutrophil function. In addition, neuroimmune regulation of cytokine production by spleen-derived macrophages obtained from alcohol-intoxicated hemorrhaged animals was impaired when examined in vitro. We hypothesize that impaired neuroendocrine activation contributes to hemodynamic instability, which, in turn, prolongs tissue hypoperfusion and enhances risk for tissue injury. Specifically, the early dysregulation in counterregulatory responses is hypothesized to affect host defense mechanisms during the recovery period. We examined host response to systemic (cecal ligation and puncture) and localized (pneumonia) infectious challenge in animals recovering from hemorrhage during acute alcohol intoxication. Increased morbidity and mortality from infection were observed in alcohol-intoxicated hemorrhaged animals. Our results indicate that alcohol-induced alterations in early hemodynamic and neuroimmune responses to shock have an impact on susceptibility to an infectious challenge during the early recovery period.

Use of anabolic steroids to attenuate the effects of glucocorticoids on the rat diaphragm.

BACKGROUND AND PURPOSE: Administration of glucocorticoids results in atrophy and contractile dysfunction in the rat diaphragm. Anabolic steroids may be useful in preventing atrophy and contractile dysfunction. The purpose of this study was to assess the effects of simultaneous administration of testosterone and glucocorticoids on morphological and contractile properties of the rat diaphragm. SUBJECTS: Eighty-eight adult female Sprague-Dawley rats were divided into 1 of 4 groups: a control group that was given sham injections for 13 days (CONT group, n=23), a group that was given prednisolone injections (0.5 mg/100 g) for 10 days (PRED group, n=23), a group that was given testosterone injections (0.5 mg/100 g) for 13 days (TEST group, n=18), and a group that was given a combination of prednisolone and testosterone injections (0.5 mg/100 g) for 10 and 13 days, respectively (COMBO group, n=23). METHODS: The animals were weighed daily, and drug doses were adjusted to changes in body mass. Twenty-four hours following the final injection, animals were weighed and sacrificed and the diaphragm was removed and weighed. A small strip of diaphragm was attached to a force transducer to determine normalized maximal isometric tetanic tension (PO). RESULTS: Body weights in the PRED group were decreased by 26% as compared with body weights in the CONT group, and body weights in the COMBO group were decreased by 11% as compared with body weights in the CONT group. Diaphragm weights in the PRED and COMBO groups were decreased by 22% and 12%, respectively, as compared with diaphragm weights in the CONT group. Normalized maximal isometric tetanic tension was decreased by 11% in the PRED group as compared with PO in both the CONT and TEST groups and was decreased by 13% as compared with PO in the COMBO group. There was no difference in PO among the CONT, TEST, and COMBO groups. DISCUSSION AND CONCLUSION: The results support the hypothesis that simultaneous administration of testosterone with glucocorticoids would prevent a decrease in PO. The results indicate that simultaneous administration of testosterone with glucocorticoids prevented the loss in body weight and partially attenuated the loss in diaphragm weight that is commonly observed when glucocorticoids are given alone. These data support the notion that testosterone may be useful in the prevention of glucocorticoid-induced atrophy.

Cardiac myosin phenotype remodelling following adrenodemedullectomy and chronic 6-hydroxydopamine in male Sprague-Dawley rats.

BACKGROUND: An increase was previously found in relative beta myosin heavy chain (MyHC) in the right ventricle of rats following thoracic spinal transection. It was hypothesized that the MyHC remodelling that was observed might be due, in part, to autonomic influences on the right ventricle. OBJECTIVE: To evaluate cardiac myosin phenotype following 21 days of reduced sympathetic activity. METHODS: Adult male Sprague-Dawley rats underwent either adrenodemedullectomy/chemical sympathectomy (SX) or sham operation/sham injection (CN). Twenty-one days following surgery, the animals were sacrificed and both ventricles were harvested. The ventricles were denatured and run on sodium dodecyl sulfate-polyacrylamide gel electrophoresis for identification of MyHC isoforms. RESULTS: SX resulted in a significant decline in catecholamines. In the right ventricle, beta MyHC ratio was twofold higher in SX animals than in CN rats, but there was no difference between groups in beta MyHC concentration in the left ventricle (P<0.05). Uniquely, we found a decrease in relative alpha MyHC in the right ventricle but no change in the myosin phenotype in the left ventricle. CONCLUSIONS: These data potentially indicate that MyHC concentrations in the left ventricle are less sensitive than the right ventricle to decreased sympathetic activity.