Leading Change Together: Supporting Collaborative Practice through Joint Accreditation for Interprofessional Continuing Education.

Interprofessional continuing education in support of team-based care is a critical component of healthcare quality and safety. In an effort to develop and advance the field of interprofessional continuing education (IPCE), the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) collaborated to launch Joint Accreditation for Interprofessional Continuing Education™, the first and only accrediting body in the world to offer the opportunity to be simultaneously accredited to provide CE activities for multiple healthcare professions through a single, unified application process, fee structure, and set of accreditation standards. To date, seven additional professions have joined Joint Accreditation: athletic trainers, dentists, dieticians, optometrists, physician associates/physician assistants (PAs), psychologists, and social workers. With this expansion, jointly accredited organisations can choose to offer IPCE for up to ten professions without needing to attain separate accreditations. Jointly accredited providers are able to offer education that is designed for single professions, multiple professions, and interprofessional teams, as long as 25% of the education is interprofessional. This innovation facilitates and incentivises IPCE which leads to improved healthcare delivery and better patient outcomes. To effectively integrate interprofessional collaborative practice throughout healthcare systems across the world, IPCE needs to become an integral part of lifelong learning for all health professions. There are several jointly accredited organisations that operate outside of the USA, and interest in Joint Accreditation and IPCE continues to grow.

Pharmacokinetic and pharmacodynamic studies of one or two doses of daclizumab in renal transplantation.

In phase III trials daclizumab was used in a five-dose regimen of 1 mg/kg at 2-weekly intervals, resulting in saturation of IL-2Ralpha on circulating lymphocytes for up to 120 days after renal transplantation. The purpose of this study was to evaluate daclizumab blood concentrations and the saturation of the IL-2Ralpha on the circulating lymphocytes with a limited dosing regimen of daclizumab. Twelve patients undergoing primary cadaver or living donor transplantation were randomized to either receive one dose (2 mg/kg) or two doses (2nd dose, 1 mg/kg) of daclizumab in addition to maintenance immunosuppression therapy consisting of either tacrolimus or cyclosporine, mycophenolate mofetil and prednisone. Patients were followed for 6 months after the transplantation. Pharmacokinetic and pharmacodynamic studies were performed up to 20 weeks after the transplantation. In patients treated with a single dose of daclizumab, the blood concentrations of daclizumab declined to 1 micro g/mL at 43 +/- 7 days after the transplantation. In patients treated with two doses of daclizumab, the blood concentrations of daclizumab declined to 1 micro g/mL at 45 +/- 13 days after the second dose for a total of 59 +/- 13 days after the transplantation. Daclizumab levels of 1 micro g/mL or greater were associated with saturation of the IL-2Ralpha on the circulating lymphocytes. In the new era of effective maintenance immunosuppression, a limited dosing regimen of daclizumab may be desired, practical and economical.

Flavonoid phytochemicals regulate activator protein-1 signal transduction pathways in endometrial and kidney stable cell lines.

Phytochemicals bind to and regulate the human estrogen receptors (ERalpha and ERbeta), mimicking actions of the endogenous estrogen, 17beta-estradiol, and known antiestrogens such as ICI 182,780. Recently, however, some of these estrogenic phytochemicals have been shown to affect other signal transduction pathways, such as receptor tyrosine kinases and mitogen-activated protein kinases (MAPK). Previously, we found that certain phytochemicals, such as flavone, apigenin, kaempferide and chalcone, have potent antiestrogenic activity. However, the antiestrogenicity of these compounds does not correlate with their ER binding capacity, suggesting alternative signaling as a mechanism for their antagonistic effects. In this study, we examined the effects of these compounds on the transcription factor activator protein-1 (AP-1). Using AP-1-luciferase stable human endometrial adenocarcinoma Ishikawa and human embryonic kidney (HEK) 293 cells, chalcone, flavone and apigenin all stimulated AP-1 activity. Additionally, we determined the effects of the phytochemicals on transcription factors that are downstream targets of various MAPK pathways. To test this, we used HEK 293 cells stably cointegrated with GAL4 transcriptional activation systems of Elk-1, c-Jun or C/EBP homologous protein (CHOP). Chalcone was the only phytochemical that activated all three transcription factors [Elk-1, 2.7-fold (P < 0.001); c-Jun, 2.7-fold (P = 0.025); CHOP, 3.0-fold (P = 0.002)], whereas apigenin stimulated CHOP (3.9-fold; P < 0.001), but inhibited phorbol myristoyl acetate-induced c-Jun activity (71%;P = 0.006). This work suggests that phytochemicals affect multiple signaling pathways that converge at the level of transcriptional regulation. The ability of flavonoids to regulate MAPK-responsive pathways in a selective manner indicates a mechanism by which phytochemicals may influence human health and disease.