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PubMed2004

Molecular epigenesis, molecular pleiotropy, and molecular gene definitions.

Recent work on gene concepts has been influenced by recognition of the extent to which RNA transcripts from a given DNA sequence yield different products in different cellular environments. These transcripts are altered in many ways and yield many products based, somehow, on the sequence of nucleotides in the DNA. I focus on alternative splicing of RNA transcripts (which often yields distinct proteins from the same raw transcript) and on 'gene sharing', in which a single gene produces distinct proteins with the exact same amino acid sequence. These are instances of molecular pleiotropy, in which distinct molecules are derived from a single putative gene. In such cases the cellular and external environments play major roles in determining which protein is produced. Where there is molecular pleiotropy, alternative gene concepts are naturally deployed; molecular epigenesis (revision of sequence-based information by altering molecular conformations or by action of non-informational molecules) plays a major role in orderly development. These results show that gene concepts in molecular biology do, and should, have both structural and functional components. They also show the need for a plurality of gene concepts and reveal fundamental difficulties in stabilizing gene concepts solely by reference to nucleotide sequence.

Animals↗
PubMed1990

A marital crisis: for better or worse.

This case study explores the relationship between Hospice of Marin's initial psychosocial assessment and interdisciplinary team communications with overall treatment outcomes. A brief review of literature is followed by presentation of methods and results. A final critical discussion suggests directions for further research.

Aged↗
PubMed1991

A process for developing a curriculum in ethics and human values.

This article describes the process and results of the deliberations of the group of authors at the 1989 spring meeting of the Northeast Group for Educational Affairs. The participants worked under the premise that someone had given an unlimited amount of money to fund a new medical school. They had to select and define what the educational goals would be and produce a plan to help students reach these goals. There had to be an evaluation process that documented progress toward the stated goals. This paper describes the ethics and human values curriculum, which should be of interest to cancer educators. The knowledge, skills, values, and attitudes are defined and the four-year process of implementing the teaching is described. This curriculum-planning process is applicable to any aspect of cancer education--first defining the outcome, then the evaluation process, and finally, how to get to that outcome.

Curriculum↗
PubMed2004

Literature on integrated HIV care: a review.

With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Vegetative and minimally conscious states: serial assessment approaches in diagnosis and management.

Assessment of vegetative (VS) and minimally conscious state (MCS) patients presents clinicians with inherent difficulties (Royal College of Physicians, 2003) in terms of the reliable detection of potential signs of awareness given that all current assessment tools rely on observed behaviour. Recently developed measures such as SMART (Gill-Thwaites & Munday, 1999) and WHIM (Shiel et al., 2000), employing structured operational defined behavioural observations can facilitate the serial assessment of patient awareness, progress and appropriate goal setting particularly as one-off bedside assessments are more likely to be inaccurate. The use of sensitive tailored approaches involving experienced multidisciplinary teams is strongly advocated (Royal College of Physicians and British Society of Rehabilitation Medicine, 2003), notwithstanding clinicians should carefully consider potential confounding clinical factors, which may deleteriously influence patient arousal or ability to respond. Finally, areas for future development and recommendations regarding multidisciplinary assessment approaches with VS and MCS patients are outlined.

Awareness↗
PubMed2006

Alphabetical prejudice in team discussions (or would Zebedee ever get seen on a ward round).

PURPOSE: To ascertain whether the order in which patients are discussed in a team meeting determines the time spent on discussion. DESIGN: Prospective study over 18 consecutive multidisciplinary team meetings. SETTING/SUBJECTS: Multidisciplinary team meetings on a Brain Injury Rehabilitation Unit, Edinburgh. MAIN OUTCOME MEASURE: Time spent discussing each case. RESULTS: Patients discussed early on received 3-4 minutes more discussion time than those later on. This was highly significant on a one-way analysis of variance (P < 0.001). CONCLUSIONS: Preferential treatment of patients who come at the start of the team meeting is a real phenomenon. Such alphabetical prejudice, where it exists, should be addressed.

Bias↗
PubMed2006

The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders: a case report.

PURPOSE: This paper presents a case report of collaborative work between speech and language therapy (SLT) and music therapy (MT) in the case of an individual presenting with complex communication difficulties and lability caused by pseudo-Parkinsonian vascular disease. DESIGN: MT intervention was used to investigate whether participation could be enabled in a client presenting with complex problems as well as facilitate change in communication parameters which remained unresponsive to conventional SLT intervention. A single case design measured communication and well-being parameters using pre-, during and post-intervention measures. In addition, analysis of the client's musical responses was undertaken to examine changes in vocal functioning which are involved in communication. RESULTS: Analysis of the client's performance during MT intervention revealed improvements in prosody and phonation, with positive reports of participation, reduced incidence of lability and improvements in measures of well-being. CONCLUSIONS: The results indicate the value of such collaborative working in addition to making recommendations for the modification of existing treatment protocols. The findings highlight that fatigue is a major consideration when working with people with severe and complex clinical presentations.

Aged↗
PubMedDate not supplied

Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice.

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.

Adult↗
PubMed2005

Strategies of international cooperation in an international project: advantages and pitfalls.

The MEPS (musculoskeletal--eyestrain--psychosocial--stress) study involved an extensive degree of multidisciplinary and multicultural cooperation. The objective was to examine the effects of multiple ergonomic interventions on visual, musculoskeletal, postural, and psychosocial outcomes amongst operators of visual display terminals (VDTs). The inherent complexity of a comprehensive ergonomic investigation requires participation of researchers from a variety of disciplines, as well as comparisons among populations with different geographical and cultural backgrounds. The design and execution of the resulting research protocol presents a number of challenges. This paper discusses the advantages and pitfalls associated with multidisciplinary multinational cooperation. Advantages include the necessity for development of a common language and perspective providing a basis for future collaboration. Pitfalls include logistic and coordination difficulties associated with conducting standardized procedures in different locations, as well as the inherent potential for professional conflict. It is argued that such pitfalls ought to be understood and integrated into the project planning process.

Clinical Protocols↗
PubMed2003

Lessons learned from implementing multidisciplinary health professions educational models in community settings.

This article addresses sustainability elements for multidisciplinary health professions education in communities. The results are based on a 5 year program involving multiple health professions education institutions in seven states within the USA. We offer observations and suggestions to others who plan and implement multidisciplinary programs for health professions educators. Our findings are based on the outcomes of the Community Partnerships in Health Professions Education (CPHPE) initiative funded by the W. K. Kellogg Foundation. Data sources included pre and post surveys of students and faculty, site visits, published evaluations and site reports, and a 2 year follow-up evaluation after the external funding phase. Elements of the partnership that facilitated the sustainability of the models were: leadership, complementary missions, curriculum that mirrors clinical community practice, change from outside in, partnership boards, and faculty development. Those elements that were barriers to sustaining the efforts were: professional identities and territorial boundaries, structural differences, costs, and unclear goals. The multidisciplinary components of the community partnership initiative were the most challenging. However, in most programs, they did succeed and are currently in place. By paying attention to the elements that enhance and detract from teaming, one can plan for more successful multidisciplinary education.

Allied Health Personnel↗
PubMed2003

Using co-teaching as a means of facilitating interprofessional collaboration in health and social care.

In this paper we report the findings of a collaborative enquiry on our experience as tutors co-teaching interprofessional collaboration to a multidisciplinary group of undergraduates. We have different professional/academic backgrounds and the student group included health and social work professionals alongside a number of non-professionals. Our data included our perceptions of the co-teaching experience collected by means of our reflective diaries and reflective conversations during planning and after teaching sessions. We also collected data on student perceptions elicited by means of student evaluations and a student focus group discussion. The data illuminate the process of using co-teaching to role model shared learning and collaborative working within the classroom and highlight the importance of carefully planning co-teaching interaction, including the use of humour, tension, different knowledge bases and styles of debate. The deliberate use of the interactions made possible by coteaching enabled us to create an active learning environment that facilitated the teaching of collaboration. Drawing on our experience, we discuss the considerable potential of using co-teaching to role model collaborative working for multidisciplinary student groups.

Attitude of Health Personnel↗
PubMed2005

Core topics of health care ethics. The identification of core topics for interprofessional education.

OBJECTIVES: The aim of this project was to identify core topics of health care ethics that could be taught through an inter-professional approach to undergraduate education. DESIGN: Five nominal group technique workshops. SETTING AND PARTICIPANTS: Teaching staff from different professional disciplines in our university (nursing branches, occupational therapy and physiotherapy). RESULTS: Seven core topics of health care ethics that are common across all disciplines were identified. However participants in all workshops identified the need for case studies used in teaching and learning to be specific to the clinical setting encountered by the student. CONCLUSION: Despite the identification of core topics that apply to all disciplines, caution should be taken when seeking to integrate these into an inter-professional undergraduate programme. There is evidence from other studies that students have difficulty in transferring knowledge from one context to another. In view of this, an inter-professional approach to health care ethics teaching to a group, members of which do not encounter shared clinical ethical problems may be inappropriate. It is suggested that inter-professional learning in undergraduate health care ethics should focus on facilitating learning in the clinical area with students who share similar ethical encounters, in which case the learning will be truly inter-professional.

Bioethics↗