Predicting performance in health professions education programs from admissions information - Comparisons of other health professions with pharmacy.

BACKGROUND: The goal of the present review was to assess the state of performance prediction in healthcare programs generally, versus performance prediction in pharmacy schools, using didactic and non-didactic admissions measures. This is important because clinical success represents a combination of skills that are not fully predicted by either type of measure alone. METHODS: PubMed searches were conducted focusing on work published from 2000 onwards, since it is during this period that non-didactic admissions measures have come to be incorporated into the applicant evaluation process. Relevant free full text papers available were used. When these papers were not available by direct import into EndNote, we went directly to the journal to try to retrieve the paper. RESULTS: We acknowledge that health professions programs have been successful in recruiting excellent candidates into their schools. However, based on the modest amount of healthcare program performance accounted for by didactic measures, admissions committees should consider expanding their holistic evaluation of applicants. Schools would benefit from using two-step screening phases in the application process - perhaps evaluating didactic potential in phase 1 and experiential in phase 2. Using combination measures throughout the admission process should help ensure admission of students more likely to be successful throughout their healthcare practice. IMPLICATIONS: Future investigations of the prediction of healthcare program performance by formal combinations of didactic and non-didactic admissions measures are imperative. In addition, it is likely that combination admission measures will incorporate more metrics of critical thinking than do simpler approaches. Furthermore, systematic evaluation of the usefulness of the two-step screening approaches to admissions used by most competitive health professions programs also needs to be done.

Application of a Skin Adhesive to Maintain Seal in Negative Pressure Wound Therapy: Demonstration of a New Technique.

Optimal wound healing with negative pressure wound therapy (NPWT) relies on a properly sealed vacuum system. Anatomically difficult wounds impair the adhesive dressing, which results in air leaks that disrupt the integrity of the NPWT system and hinder wound healing. OBJECTIVE: The authors demonstrate a new technique using a cyanoacrylate-based tissue adhesive to maintain an airtight, durable seal in NPWT. MATERIALS AND METHODS: A 52-year-old woman with a degloving injury to the right thigh extending into the groin, resulting in massive necrosis, presented to the emergency department. Using a skin closure system, 2 polyester mesh tape strips were placed near the perineal region of the wound to reinforce the adhesive drape of the NPWT system. Skin grafts were applied over the wound after about 3 weeks of NPWT, and the skin closure system was applied in the same fashion to reinforce the adhesive drape. RESULTS: An airtight seal was consistently maintained for several days in between dressing changes. The size of the wound was visibly reduced at each dressing change. An airtight seal was maintained for 5 days after placement of the skin grafts; after 5 days, the dressing was removed without difficulty and skin irritation. The skin grafts appeared healthy with adequate tissue take. CONCLUSIONS: Maintaining an airtight seal in NPWT is crucial to wound healing. Cyanoacrylate tissue adhesives appear to be a safe and viable option for creating a durable seal in NPWT for wounds in anatomically difficult locations.

The Application of Skin Adhesive to Maintain Seal in Negative Pressure Wound Therapy.

BACKGROUND: Optimal wound healing in negative pressure wound therapy (NPWT) depends on a properly sealed vacuum system. Anatomically difficult wounds disrupt the adhesive dressing, resulting in air leaks that impair the integrity of this system. Several techniques have been used in previous reports to prevent air leaks, including the addition of skin adhesives (eg, Skin-Prep [Smith and Nephew, St. Petersburg, FL] or compound tincture of benzoin), hydrocolloid dressings, silicone, and stoma paste. The purpose of this case report is to demonstrate the effectiveness of using a cyanoacrylate tissue adhesive, dermaFLEX (FLEXCon, Spencer, MA), in maintaining an airtight, durable seal in NPWT. MATERIALS AND METHODS: The authors present a patient with a difficult to manage anogenital wound where efforts to maintain an airtight seal in NPWT proved difficult. It was decided during the course of treatment to use the cyanoacrylate tissue adhesive to create an airtight, durable seal. The tissue adhesive was applied circumferentially to the skin surrounding the wound edge. After placement of vacuum-assisted closure foam over the wound, the adhesive dressing was applied with its edges overlapping the skin area where the tissue adhesive was applied. RESULTS: The size of the wound was visibly reduced at each dressing change. An airtight seal was consistently maintained for 3 days at a time, surviving the difficult environment of the wound and maximizing the life of each adhesive dressing. CONCLUSION: For wounds in anatomically challenging locations, the use of the tissue adhesive appears to be a safe and viable option in creating a durable seal in NPWT.

Theories and treatment of drug dependency: a neurochemical perspective.

Treatment of chemical dependence ("addiction") requires an understanding of its effects on the brain. To guide research in the area of chemical dependence, several foundational theories have been developed. These include the incentive salience, receptor down-regulation, opponent process, and psychomotor stimulant theories. These have been important both in summarizing and in guiding investigations. However, the extant theories do not provide a single unified framework nor have they yielded all of the guidance necessary for effective chemical dependence treatment. The present paper summarizes and then integrates these theories and suggests some implications for the treatment followed by this integration.

The use of bioelectric dressings in skin graft harvest sites: a prospective case series.

Despite advances in wound care treatments for the management of acute and chronic wounds, there remains an unmet need for interventions that accelerate epithelialization. Many authors in the past have advocated the use of electric currents to accelerate wound healing. Novel wound dressings with inherent electric activity are emerging, and studies of these specific modalities are lacking. The principal aim of this study is to evaluate the impact of a bioelectric dressing on acute wound healing. Thirteen patients who underwent skin grafting were enrolled. One half of all skin graft donor sites were treated with the bioelectric dressing and semi-occlusive dressing (SOD) and the other half using solely a SOD. Epithelialization was rated by a blinded burn surgeon attending. Participants also provided a self-assessment of their scar appearance. At week 1 postprocedure, average epithelialization of 71.8% was noted on the bioelectric dressing-treated side, compared with 46.9% on the SOD side, representing an average 34.62% faster wound healing (P = .015). At 1 month, patients rated the bioelectric dressing-treated half as superior in terms of scar color (P = .198), stiffness (P = .088), thickness (P = .038), and overall quality (P = .028). These early data show promise in terms of faster healing, improved scarring, and improved patient subjective outcome with the use of the bioelectric dressing on acute wounds. With fulfillment of an extended study population, the authors hope to provide a solid foundation for extrapolating their data beyond skin graft donor sites to all areas of wound care.

Outdoor recreational fires: a review of 329 adult and pediatric patients.

Outdoor recreational fires are a frequent occurrence during the summer months and can be associated with burns resulting in significant morbidity. Both pediatric and adult populations can be affected, and their mechanism of injury is often different. Understanding these mechanisms is important when designing prevention programs. It is the goal of this study to review our experience with outdoor recreational fires. All patients who presented to Spectrum Health Blodgett Regional Burn Unit for burns secondary to an outdoor recreational fire over an 8-year period were reviewed. Demographic data, mechanism of injury, body area involved, TBSA burned, treatments undertaken, and subsequent complications were recorded. Pediatric patients (aged 16 years and younger) were analyzed independently, and risk factors were determined. A total of 329 patients suffered burns secondary to outdoor recreational fires over the length of the study. More than 35% required inpatient treatment, with an average length of stay of 4.8 days. Hands were the most frequently affected body part, with the mean TBSA involved being 3.5%. Ninety-four patients (28.6%) required split-thickness skin grafting. The most common mechanism of injury in both adult and pediatric populations was falling into an ongoing fire. Wound infection was the most common complication. Alcohol intoxication was associated with a higher burn severity and complication rate. Pediatric patients represented 39.8% of the sample. Burns secondary to outdoor recreational fires are associated with significant morbidity. Adult prevention programs should target awareness with respect to alcohol consumption and campfires secondary to the morbidity associated with these injuries. Pediatric patients are particularly susceptible, and parents should remain diligent about campfire safety and be educated about the inherent dangers of both active and extinguished fires.

Necrotizing colitis caused by systemic aspergillosis in a burn patient.

The incidence of invasive fungal infections has continued to rise over the past three decades, especially in the immunocompromised and intensive care unit population. Candida species are the most common pathogen to cause such invasive infections. However, Aspergillus species are currently on the rise and constitute a much more aggressive and serious infection. All Aspergillus species cause a wide spectrum of diseases from colonization to hypersensitivity reactions. It can also cause chronic necrotizing infections leading to rapidly progressive angioinvasion, often resulting in death. Invasive Aspergillus infection almost always occurs in patients who are immunosuppressed. We report here a case of aspergillosis causing invasive systemic infection and mycotic colitis in a burn patient. The clinical presentation was one of septic shock with rapidly progressing dissemination leading to necrotizing colitis and eventual demise. Pathologic findings involved necrotizing enterocolitis with invasive Aspergillus hyphae. Given the rarity of this entity and usual progression to death in humans, proper diagnosis and treatment of such fungal infections are being investigated. Reports are reviewed, and possible mechanisms resulting in Aspergillus infection in this individual are discussed.

Dressing ignition and facial burns following orbital exenteration.

A 49-year-old woman with type II diabetes mellitus and a history of smoking underwent partial eyelid-sparing exenteration of the right orbit and antifungal therapy for zygomycosis. The medial orbital wall healed with a 7-mm fistula to the ethmoid sinus and a moist granulating apex required daily dressing changes for several months. Eighteen weeks following surgery, the patient cleaned her face with an alcohol wipe and then lit a cigarette, igniting the dressing covering the exenterated eye socket. This caused severe burns to the periorbital regions of both eyes requiring debridement, allografts, and then split-thickness skin grafting. Factors predisposing to this unusual and serious complication of orbital exenteration are reviewed and the subjects of treatment and prevention are discussed. To our knowledge, this is the first reported case of dressing ignition with serious facial burns in a postexenteration patient.

Educating treatment professionals about addiction science research: demographics of knowledge and belief changes.

Communication of accurate, objective, and timely scientific information to treatment professionals is important--especially in the "drug abuse" and addiction field where misinformation and a lack of exposure to new information are common. The purpose of this study was to assess knowledge and belief changes that accompanied educational workshops (3 or 6 hr-long) on addiction science targeted to treatment professionals (N=1403) given in the United States and Puerto Rico between July 2000 and August 2001. Each workshop covered three main concepts: (1) terms and definitions; (2) basic neurochemistry of addiction; and (3) how new neurobiological knowledge will affect the treatment of addictions in the future. Analysis of variance was used to compare mean pretest to posttest change scores among levels of four independent variables: gender, age, occupation/position, and race/ethnicity. Workshop participants achieved a significant improvement in knowledge about addiction with younger groups achieving greater gains. Participants' beliefs shifted in the desired direction. Significant differences in belief shifts occurred among occupational and gender groups, but not among race/ethnicity or age groups. There was also a consistent change in the policy belief subscale that related to how strongly the audience members believed research on addiction was important. We conclude that addiction science education provided to treatment professionals can increase their knowledge and change their beliefs about the causes of addictions. In addition, the workshop participants form a base of constituents who are likely to support greater addiction research funding.

Prevention of relapse to addiction: information for the practitioner.

The purposes of this review are to convey the current distinction between pathological drug dependence and voluntary drug abuse; to provide an overview of the anatomy and biochemistry of dependence; to discuss the rationale for attempting to prevent relapse by using therapeutic agents; and to describe effective agents that reduce relapse in alcohol- and opioid-dependent people. Drug dependence (formerly called "addiction") has as its essential characteristic "impaired control over use of the drug." Impaired control occurs when pathways are sensitized within the emotional brain, (usually) in genetically predisposed individuals. At the nerve cell level, impaired control occurs because of a type of neural adaptation (change in synaptic plasticity) within the pathway's nerve cells that alters their chemistry. Relapse in alcohol-dependent patients can be prevented by any of several agents that reduce craving for alcohol: naltrexone (ReVia), ondansetron (Zofran), and acamprosate (Campral, not yet available in the United States). Relapse in opioid-dependent patients can be prevented by the full agonists methadone and L-alpha-acetyl-methadol (LAAM) and the partial opioid agonist buprenorphine (Subutex and Suboxone). No other universally effective anti-relapse medications exist for other chemical dependencies.

Effectiveness of addiction science presentations to treatment professionals, using a modified Solomon study design.

OBJECTIVES: Knowledge of addiction research findings is critical for healthcare professionals who treat addicted patients. However, there is little information available about the instructional effectiveness of lecture-slide presentations in changing knowledge vs. beliefs of such professionals. DESIGN: A modified Solomon four-group experimental design was used to assess the instructional effectiveness (knowledge gain vs. belief changes) of three-hour addiction science workshops presented to health-care professionals by neurobiologically-trained academic researchers. Effectiveness of the workshops was assessed by a 28-item questionnaire on participant versus control group knowledge/beliefs on addiction. Six-month follow-up questionnaires measured "retention" of knowledge and belief changes. RESULTS: The workshop participants showed significant knowledge gain and belief changes, whereas the two control groups showed no change in knowledge or beliefs. After six months, knowledge gains decreased, but were still higher than pre-test scores. In contrast, belief changes on three subscales persisted over six months in 40 to 52 percent of the subjects. CONCLUSIONS: These results illustrate a successful continuing education model by which academic researchers who are skilled teachers present a three-hour lecture-slide workshop with extensive question-and-answer sessions on addictions. We conclude that motivated health-care professionals can experience important knowledge gains and belief changes by participating in such workshops. In contrast to the transient retention of knowledge, belief changes persisted surprisingly well for at least six months in about half the subjects. These results suggest that long-term changes in the professional orientation of these health-care workers are possible.

Comparative molecular field analysis (CoMFA) for sulfoxidation reactions in Mortierella isabellina ATCC 42613 and Helminthosporium sp. NRRL 4671.

Previous models for mechanisms of enzymatic sulfoxidation have been somewhat limited by a lack of knowledge of the essential features of substrate-enzyme versus product-enzyme relationships. Computerized methods for modeling ligand-protein (substrate-enzyme) interactions can overcome some of these limitations. Specifically, CoMFA (comparative molecular field analysis) provided a useful general approach in which to evaluate substrate-enzyme and product-enzyme relationships. The present investigation examined the relationship between substrate and product structure in predicting enantioselective sulfoxidation reactions using CoMFA for two species of microorganisms that have been used as models for mammalian metabolism, Mortierella isabellina and Helminthosporium sp. The overall enantioselectivity observed was based on the composite stereoselectivity of sulfoxide formation, sulfone formation (from the sulfoxide), and sulfoxide reduction back to the achiral substrate (sulfide).

Antagonistic effects of dopaminergic signaling and ethanol on protein kinase A-mediated phosphorylation of DARPP-32 and the NR1 subunit of the NMDA receptor.

BACKGROUND: This article extends our initial investigation of the interactions between dopamine and glutamate receptor systems after acute exposure to ethanol. DARPP-32 (dopamine and cyclic adenosine monophosphate-regulated phosphoprotein of approximate molecular weight 32 kDa) is an important regulator of protein phosphatase-1 that in turn regulates a large number of effectors, including the NMDA receptor. METHODS: We measured the protein kinase A (PKA)-mediated phosphorylation of DARPP-32 and the NR1 subunit of the NMDA receptor. Initially, corpus striatum was assayed after intraperitoneal treatment of mice with the D1 agonist SKF82958, the D2 agonist and anticraving drug bromocriptine, or ethanol. In other experiments we blocked D1 receptors with the selective D1 antagonist SCH23390 or blocked D2 receptors with the selective D2 antagonist eticlopride. Finally, we examined combinations of some dopaminergic drugs with and without ethanol. RESULTS: SKF82958 alone significantly increased PKA-mediated phosphorylation of both DARPP-32 and NR1. Bromocriptine alone had no effect on pDARPP-32 or on pNR1. However, when D1 receptors were blocked, bromocriptine reduced the PKA-mediated phosphorylation of both DARPP-32 and NR1. Coincident treatment with bromocriptine and ethanol reversed both of these effects with D1 receptors blocked. The combination of eticlopride (D2 blocker) and SF82958 (D1 agonist) did not significantly alter either pDARPP-32 or pNR1. CONCLUSIONS: These data demonstrate antagonistic effects of acute ethanol exposure on D1 signaling in vivo and the potential of acute in vivo challenge protocols to help fill gaps in the understanding of ethanol's effects on protein phosphorylation.