Faculty Perspective on Interprofessional Education Competencies: Respiratory Therapy Compared to Other Allied Health Professions.

BACKGROUND: Interprofessional Education (IPE) provides a framework for collaborative education between health care specialties to improve patient care. In 2010, the Interprofessional Education Collaborative Expert Panel established the competencies of communication, ethics, roles and responsibilities, and teams and teamwork. Studies have assessed knowledge and attitudes about IPE in several allied health educational programs including respiratory therapy (RT). METHODS: We compared RT faculty to athletic training (AT), nutrition (NT), occupational therapy (OT), physical therapy (PT), and dental hygiene (DH) faculty. Faculty were asked to rank the IPE competencies according to importance. RESULTS: RT faculty ranked communication first, then teams and teamwork, roles and responsibilities, and last ethics. A Kruskal-Wallis Dwass-Steel-Chritchlow-Fligner pairwise analysis showed statically significant differences among allied health faculty rankings of IPE competencies. In communication, RT faculty responded statistically higher than AT (P < .001), DH P < .001), NT P < .001), and OT (P = .003). In ethics, RT faculty responded statistically lower than DH (P < .001), NT (P = .01), and PT (P < .001). In roles and responsibilities, RT faculty responded statistically higher than AT (P = .007) and OT (P < .001). In teamwork, RT faculty responded statistically higher than AT (P = .02), DH (P < .001), OT (P = .002), and PT (P < .001). CONCLUSIONS: RT faculty who teach at different degree levels (associate's degree programs vs bachelor's and master's degree programs) had the same ranking of competencies, but they had a statistically significant difference for teamwork, with associate's degree faculty ranking teamwork lower than bachelor's and master's degree faculty.

Imatinib-responsive hypereosinophilia in a patient with B cell ALL.

Hypereosinophilia is a rare presenting sign of acute lymphocytic leukemia. A 29-year-old male was diagnosed with idiopathic hypereosinophilic syndrome with respiratory symptoms. Although his peripheral blood eosinophilia decreased in response to treatment with imatinib mesylate, a follow-up bone marrow showed a diffuse infiltrate of myeloperoxidase-negative blasts. He was subsequently diagnosed with CD10 positive precursor B lymphoblastic leukemia. This case underscores the importance of follow-up bone marrow examination in patients who demonstrate imatinib mesylate-responsive eosinophilia.

Vaso-occlusion in children with sickle cell disease: clinical characteristics and biologic correlates.

Vaso-occlusive pain is a frequent manifestation of sickle cell disease, but most clinical studies have documented only those pain episodes for which patients seek acute care or require hospitalization. Based on limited previous studies, the authors suggest that pain episodes managed at home are more frequent then those resulting in acute care management but likely share a common pathophysiology. The authors determined the characteristics of vaso-occlusive pain managed at home in 30 subjects (ages 6-19 years) using a self-report diary daily for 6 months. A total of 175 pain episodes were reported in 4,885 days, with 51% lasting 1 day or less. Severe pain, rated as 7 to 10 on a 10-point scale, was reported on 12% of pain days, but most pain was of mild to moderate intensity. A combination of baseline hematologic parameters and biomarkers assessing erythrocyte/endothelial cell adhesion, including hematocrit, fetal hemoglobin, and adhesion ratio, were statistically significant predictors of pain frequency in statistical analyses. Given the overlap in clinical features and predictive hematologic parameters of home-managed and acute care-managed pain, both likely represent a continuum of frequency and severity rather than distinct clinical entities. The higher frequency of these home-managed episodes suggests their potential utility as additional outcome measures in studies of vaso-occlusive pain.

Physical and cognitive-behavioral activities used in the home management of sickle pain: a daily diary study in children and adolescents.

BACKGROUND: There is little information documenting the use of cognitive-behavioral and physical pain relieving activities by children and adolescents for management of pain related to sickle cell disease (SCD). METHODS: Thirty-seven subjects (aged 6-21 years) used a daily self-report pain diary for 6 months to 3 years to report their home pain experience and its pharmacologic and non-pharmacologic management. RESULTS: A total of 514 vaso-occlusive pain episodes (2,592 days) were reported. Cognitive-behavioral or physical pain management activities were used alone on 7.5% of these pain days, and with analgesics on 77%. Female gender (P = 0.003) and increasing pain intensity (P = 0.04) were associated with an increased number of activities used. Increasing pain intensity was also associated with usage of several specific activities. CONCLUSIONS: Patients and families frequently used cognitive-behavioral and physical activities in addition to oral analgesics to treat sickle cell-related pain at home, and may benefit from additional training and support.

Home management of pain in sickle cell disease: a daily diary study in children and adolescents.

PURPOSE: To determine the incidence of pain and the types of home pain management techniques used by children and adolescents with sickle cell disease (SCD) and their caregivers. PATIENTS AND METHODS: Thirty-seven children and adolescents (ages 6-21 years) with SCD used a self-report pain diary twice daily to report their pain experience and its management for 6 months to 3 years. A total of 18,377 diary days representing 514 distinct pain episodes were analyzed. RESULTS: Pain related to SCD was reported on 2592 days and 2326 nights, with analgesic medication taken on 88% of days and 76% of nights. A single oral analgesic was used on 58% of these days. On the remaining days, multiple analgesics were used in a variety of combinations. More frequent analgesic dosing was reported on days with more intense pain. Pain relief was substantially better for analgesic combinations than for single analgesics, particularly for moderate to severe pain. CONCLUSIONS: Pain went untreated on a modest number of days, and many patients relied on relatively ineffective single analgesics. Other patients and families appropriately used potent analgesic combinations in a time-contingent and intensity-dependent pattern. This study suggests that recurrent acute pain from SCD can be successfully managed at home with appropriate training and supervision, and suggests several areas for intervention to improve patient outcomes.

Characteristics of pain managed at home in children and adolescents with sickle cell disease by using diary self-reports.

Pain can begin in the first year of life for individuals with sickle cell disease (SCD) and continue in an unpredictably recurrent manner throughout their life span. Sickle vaso-occlusive pain (sickle pain) can also occur simultaneously with pain of other origins, complicating both assessment and management. Aims of this research were to describe the reliability and validity of a daily diary for data collection with children and adolescents with SCD and to describe characteristics of vaso-occlusive sickle pain episodes (VOE) and other pain reported by children and adolescents with SCD along with home pain management strategies. Thirty-nine children and adolescents (mean age, 10.9 +/- 3.6 years) completed diaries twice daily at home for up to 3 years (mean, 417.9 +/- 272.2 diary days) with excellent compliance. Sickle pain alone was reported on 8.4% of days (n = 1515 days), whereas other pain occurred on 2.7% of days (n = 490) and both sickle pain and other pain on 5.7% (n = 1041 days). Other pain only episodes were shorter and involved fewer sites than sickle pain only episodes. Sickle pain occurred in the extremities and hips, whereas most other pain occurred in the head-neck area. Analgesic medication was taken on 85% of days of sickle pain, whereas analgesics were taken on only 60% of days with other pain. The diary used in this study is a valid and reliable self-report tool. The use of home diaries will improve the understanding of sickle pain and its management and assist in identifying other pain syndromes that may require alternative management.

Caregiver report of pain in infants and toddlers with sickle cell disease: reliability and validity of a daily diary.

Pain is a hallmark sign of sickle cell disease (SCD) with more than 80% of vaso-occlusive episodes managed at home. This study explored the pyschometric properties of a daily pain and symptom diary and compliance of caregiver report in young children with SCD during a 1- to 2-year period. Compliance for completing diary entries for the first year with 16 caregivers was 90.6% and 86.2% with 19 respondents for the first 2 years. A Cronbach alpha of 0.86 was calculated for 12 items in the diary during a period of 1,450 diary days. Test-retest reliability analysis yielded 99.8% agreement between written entry and stated data entry. Interitem correlations for the 16 respondents ranged from 0.11 to 0.89 (mean, 0.52). Scale reliability estimates were quite strong, ranging from 0.50 to 0.99 (mean, 0.85). Construct validity was supported with significant relationships between caregiver report of giving medications when SCD pain was identified (chi-square = 98.0, P < .0001) and providing other help to relieve SCD pain (chi-square = 8.36, P < .004). The results provide evidence that the Infant/Toddler Diary is a reliable, valid measure of pain and illness report by caregivers of young children with SCD.