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PubMed2005

Worldwide use of the ketogenic diet.

PURPOSE: Over the past decade, the use of the ketogenic diet internationally has increased dramatically. The purpose of this survey was to evaluate the use of the diet worldwide. METHODS: With the use of the Internet, e-mail requests for information about international ketogenic diet centers (outside the United States) were made over a 9-month period. Assistance also was obtained from the Child Neurology Society and International League Against Epilepsy. Questions included patient enrollment (total and annually), year the diet was first offered, unique cultural and religious issues in the country, community opinion, and research interests. RESULTS: Successful communication was made with 73 academic centers in 41 countries outside the United States. Sixteen (39%) countries provided information from multiple centers. The median duration offering the diet was 8 years (range, 1-45 years). The average number of patients enrolled to date was 71.6 per country, with 5.4 new patients annually. Common difficulties included avoiding rice intake, tolerating higher fat-to-protein and carbohydrate ratios (e.g., 4:1), finding specific nutritional labels on foods, and handling the growing interest from large populations with limited resources. Nevertheless, cultural and religious issues were generally not limiting; physician and patient acceptance of the diet as an option is high; and most meals were similar among countries. Centers often had great pride in their programs, and international collaborative groups are forming rapidly. A website is now available with updated center information at http://www.neuro.jhmi.edu/Epilepsy/Peds/ketoworldwide.htm CONCLUSIONS: Despite occasional difficulties, the ketogenic diet is being used worldwide.

Academic Medical Centers↗
PubMed1998

Theoretical and treatment issues of personality disorders in individualistic and collectivistic societies.

The author will attempt to equate so-called personality disorders with what used to be called psychoneurosis. Some suggestions for theoretical and technical modifications to apply psychoanalysis and psychotherapy on selective cases within the current managed care environment have been offered. In order to develop a comprehensive and effective psychotherapy system, a collaboration of psychotherapists both in collectivistic and individualistic societies is highly desirable. Furthermore, the differences of personality disorder and neurosis in both social structure are either minimal or insignificant from a psychotherapeutic point of view.

Cross-Cultural Comparison↗
PubMed2005

Severe acute respiratory syndrome epidemic in Taiwan, 2003.

In Taiwan, since the first case of severe acute respiratory syndrome (SARS) was identified on February 25, 2003, a total of 3032 cases of suspected or probable SARS were reported prior to July 5, 2003. Among these cases, 664 cases were classified as probable SARS based on the clinical case definitions and 346 had a positive result for the SARS-associated coronavirus (SARS-CoV). The epidemic in Taiwan could be divided into 2 distinct stages. In stage I (late-February to mid-April) patients had traceable contact with infected patients or travel histories to known affected areas of SARS. By contrast, patients in stage II (mid-April to June) acquired infection via intra-hospital or inter-hospital transmission. The mortality rate directly attributable to SARS during the 2 stages of the outbreak in Taiwan was 11% (37 patients). Phylogenetic analysis of sequences of SARS-CoV strains in Taiwan and other countries showed that Taiwanese strains were closely related to those isolated from patients in Hong Kong and Guangdong. The nonspecific initial symptoms and signs of the illness, the absence of reliable diagnostic tests, as well as the initial lack of strict infection control measures in hospitals and effective national control policies contributed to the island-wide spread of the SARS epidemic in Taiwan. Development of an effective strategy to prepare for future outbreaks will require the implementation of an active coordinated clinical reporting system, international collaboration to identify cases in the early stage, development of laboratory tools for early diagnosis, a robust system of prepared isolation, and adequate quarantine facilities.

Adult↗
PubMed2001

End-of-life care in the pediatric intensive care unit: attitudes and practices of pediatric critical care physicians and nurses.

OBJECTIVE: To determine the attitudes and practices of pediatric critical care attending physicians and pediatric critical care nurses on end-of-life care. DESIGN: Cross-sectional survey. SETTING: A random sample of clinicians at 31 pediatric hospitals in the United States. MEASUREMENTS AND MAIN RESULTS: The survey was completed by 110/130 (85%) physicians and 92/130 (71%) nurses. The statement that withholding and withdrawing life support is unethical was not endorsed by any of the physicians or nurses. More physicians (78%) than nurses (57%) agreed or strongly agreed that withholding and withdrawing are ethically the same (p < .001). Physicians were more likely than nurses to report that families are well informed about the advantages and limitations of further therapy (99% vs. 89%; p < .003); that ethical issues are discussed well within the team (92% vs. 59%; p < .0003), and that ethical issues are discussed well with the family (91% vs. 79%; p < .0002). On multivariable analyses, fewer years of practice in pediatric critical care was the only clinician characteristic associated with attitudes on end-of-life care dissimilar to the consensus positions reached by national medical and nursing organizations on these issues. There was no association between clinician characteristics such as their political or religious affiliation, practice-related variables such as the size of their intensive care unit or the presence of residents and fellows, and particular attitudes about end-of-life care. CONCLUSIONS: Nearly two-thirds of pediatric critical care physicians and nurses express views on end-of-life care in strong agreement with consensus positions on these issues adopted by national professional organizations. Clinicians with fewer years of pediatric critical care practice are less likely to agree with this consensus. Compared with physicians, nurses are significantly less likely to agree that families are well informed and ethical issues are well discussed when assessing actual practice in their intensive care unit. More collaborative education and regular case review on bioethical issues are needed as part of standard practice in the intensive care unit.

Adult↗
PubMed1997

Initial construct cross-cultural validation of the Short Form 36 for quality of life assessment of systemic lupus erythematosus patients in Singapore.

The objective of this study was to determine if the Short Form 36 (SF-36) Health Survey Questionnaire measures differences in quality of life between lupus patients and healthy controls in Singapore. A cross-sectional pilot study was conducted on consecutive English-speaking, female Chinese lupus patients seen at a Rheumatology unit. Healthy volunteers were recruited as controls during the same time period. All subjects completed the United Kingdom version of the SF-36. Lupus disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index and converted to a global score. Lupus-related damage was measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACRDI). The main outcomes measured were the mean SF-36 scale scores for lupus patients and healthy controls. Thirty-six lupus patients and 76 controls were included in the study. All subjects were English-speaking, Chinese female between 21 and 53 years of age. The mean age of patients and controls was 31.9 and 29.0 years respectively. Lupus patients had lower mean scale scores than controls for physical functioning (73.0 versus 89.7, P < 0.0027), bodily pain (71.0 versus 81.4, P < 0.027), physical role functioning (55.7 versus 89.5, P < 0.0001) and general health (47.4 versus 51.8, P < 0.05). Mean scale scores for vitality, social and emotional role function and mental health were similar in both groups. Ten patients had active disease (BILAG global scores of 3 to 14) and 13 patients had lupus-related damage (Damage Index scores of 1 to 7). These preliminary data suggest that the SF-36 Health Survey may be able to measure differences in quality of life between lupus patients and healthy controls in Singapore.

Adult↗
PubMed2002

FIV vaccine development and its importance to veterinary and human medicine: a review FIV vaccine 2002 update and review.

Feline immunodeficiency virus (FIV) is a natural infection of domestic cats that results in acquired immunodeficiency syndrome resembling human immunodeficiency virus (HIV) infection in humans. The worldwide prevalence of FIV infection in domestic cats has been reported to range from 1 to 28%. Hence, an effective FIV vaccine will have an important impact on veterinary medicine in addition to being used as a small animal AIDS model for humans. Since the discovery of FIV reported in 1987, FIV vaccine research has pursued both molecular and conventional vaccine approaches toward the development of a commercial product. Published FIV vaccine trial results from 1998 to the present have been compiled to update the veterinary clinical and research communities on the immunologic and experimental efficacy status of these vaccines. A brief report is included on the outcome of the 10 years of collaborative work between industry and academia which led to recent USDA approval of the first animal lentivirus vaccine, the dual-subtype FIV vaccine. The immunogenicity and efficacy of the experimental prototype, dual-subtype FIV vaccine and the efficacy of the currently approved commercial, dual-subtype FIV vaccine (Fel-O-Vax FIV) are discussed. Potential cross-reactivity complications between commercial FIV diagnostic tests, Idexx Snap Combo Test and Western blot assays, and sera from previously vaccinated cats are also discussed. Finally, recommendations are made for unbiased critical testing of new FIV vaccines, the currently USDA approved vaccine, and future vaccines in development.

AIDS Vaccines↗
PubMed1998

Methodology, results and quality of clinical trials of tacrine in the treatment of Alzheimer's disease: a systematic review of the literature.

OBJECTIVE: To review systematically the methodology, results and quality of clinical trials of tacrine in the treatment of Alzheimer's disease (AD). METHODS: Trials included were those conducted on AD patients, aged 40 years or over, assigned to tacrine- or placebo-based treatment. Studies were identified via the Cochrane Collaboration and MEDLINE databases. Trial-selection and data-extraction were carried out separately by two reviewers working independently. Any differences of opinion that arose were resolved by discussion. RESULTS: We identified 49 trials published in the period 1 January 1981 - 1 May 1997. Of these, 21 were randomized controlled trials, eight parallel-group and 13 cross-over type. In the random trials, tacrine dosage ranged from 25 to 200 mg/day, with a duration of 3-36 weeks. In all, 3555 patients with mild to moderate AD started treatment and 1149 failed to complete the course (mean 33.4% patients per trial). Over 80% of patient withdrawals were tacrine-related. Adverse events affected a mean of 59% patients per trial (range 34-90%), mainly in the form of cholinergic manifestations (mean 30.2%, range 5-62%) and transaminase elevations (mean 28.6%, range 0-53%). Adverse events were more frequent at doses of > or = 100 mg/day and disappeared on discontinuation of tacrine treatment. Just over 20% of patients given tacrine experienced improvements in cognitive function (3-4 points in Alzheimer's Disease Assessment Scale cognitive subscale and 2-3 points in Mini-Mental State Examination) and in functional ability at 3-6 months of treatment. No study gave a description of concealment of the randomization sequence or the success of the double-blind procedure. CONCLUSIONS: Tacrine shows a modest degree of efficacy among a small proportion of patients with mild to moderate AD, yet has important adverse effects which limit its clinical usefulness. It is not known which AD patient subgroup could benefit from the treatment. Information on the long-term effects of tacrine (over periods exceeding 7 months) and its effects on quality of life, patient institutionalization and mortality and patient burden on caregivers is inadequate.

Aged↗
PubMed1997

Consistency and validity of patient administered assessment of quality of life by the MOS SF-36; its association with disease activity and damage in patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the metric properties and validity of the assessment of quality of life by the MOS Short Form 36 (SF-36) in patients with systemic lupus erythematosus (SLE) and to examine the effect of disease on quality of life. METHODS: Cross sectional study of 150 patients with SLE (age: mean 39.7 yrs, SD 11.4 yrs; 95% female) attending 2 specialist lupus clinics between November 1994 and April 1995. Shortly before or after the consultation patients completed the SF-36 and the MOS SF-20 with an additional question about fatigue (SF-20+) in random order. Disease activity was measured by the British Isles Lupus Activity Group System (BILAG), disease damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SLICC). RESULTS: SF-36 domains were shown to be internally consistent (Cronbach's coefficient alpha > or = 0.71). Significant associations of the SF-36 domains with the corresponding domains of the SF-20+ and with global disease activity measured by BILAG were observed. SF-36 scores in patients with SLE were significantly lower than in controls. Different disease activity levels were significantly associated with different quality of life scores, with excellent ability to record the continuum from good health to serious illness by the SF-36. Disease activity had greater effect on quality of life than age, cumulative damage, or disease duration. CONCLUSION: This study shows the SF-36 is internally consistent and proves construct, discriminatory, and criterion validity for the SF-36 and construct validity for the SF-20+ in patients with SLE. The SF-36 is preferred because of its broader scope of questions, its widespread use, and previous international validation for a wide variety of diseases.

Adult↗
PubMed2000

Thyroid hormone for preventing of neurodevelopmental impairment in preterm infants.

BACKGROUND: Observational studies have shown an association between transiently low thyroid hormone levels in preterm infants in the first weeks of life (transient hypothyroxemia) and an abnormal neurodevelopmental outcome. Thyroid hormone therapy might prevent this morbidity. OBJECTIVES: To assess whether thyroid hormone therapy in preterm infants without congenital hypothyroidism results in clinically important changes in neonatal and long term outcomes in terms of both benefits and harms. SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal handsearching in the English language. SELECTION CRITERIA: All trials using random or quasi-random patient allocation, in which thyroid hormone therapy (either treatment or prophylaxis) was compared to a control in premature infants. DATA COLLECTION AND ANALYSIS: Primary clinical outcomes included measures of neurodevelopmental outcome and mortality. Assessment of trial quality, data extraction and synthesis of data, using relative risk (RR) and weighted mean difference (WMD), were performed using standard methods of the Cochrane Collaboration and its Neonatal Review Group. MAIN RESULTS: Eight studies were identified that compared thyroid hormone treatment to control. Four randomized or quasi-randomized studies met inclusion criteria (Chowdhry 1984, Amato 1989, van Wassenaer 1997 and Vanhole 1997). All studies enrolled preterm infants < 32 weeks gestation, but used different timing, dose and duration of treatment with thyroid hormones. Three studies used thyroxine, whereas Amato 1989 used triiodothyronine. Only two studies with neurodevelopmental follow-up were of good methodology (van Wassenaer 1997 and Vanhole 1997). All studies were of small size with the largest, van Wassenaer 1997, enrolling 200 infants. A lack of comparability of data (neurodevelopmental test or timing of follow-up) prevented meta-analytic pooling of the studies for neurodevelopmental outcomes. There was no significant difference in mortality to discharge (typical relative risk 0.74, 95% CI 0.44, 1.26) in infants who received thyroid hormone treatment compared to controls. In individual studies, no significant differences were found in neurodevelopmental outcomes including risk of abnormal neurological outcome, and Bayley Mental or Psychomotor Development Indices. No data were available for the incidences of cerebral palsy or sensorineural impairment. Fraction of inspired oxygen was lower in infants receiving triiodothyronine in one small quasi-randomized study (Amato 1989), but not in infants receiving thyroxine in a randomized study (Vanhole 1997). No other differences were found to suggest a reduced severity of respiratory distress syndrome in infants receiving early thyroid hormone therapy. REVIEWER'S CONCLUSIONS: This review does not support the use of thyroid hormones in preterm infants to reduce neonatal mortality, improve neurodevelopmental outcome or to reduce the severity of respiratory distress syndrome. The a posteriori subgroup analyses of data from one study (van Wassenaer 1997) which showed benefits in infants 24-25 weeks gestation should be treated with caution. The small number of infants included in trials incorporated in this review limits the power of the meta-analysis to detect clinically important differences in neonatal outcomes. Future trials should be of sufficient size to detect clinically important differences in neurodevelopmental outcomes. They should consider enrolling those infants most likely to benefit from thyroid hormone treatment such as infants born at less than 27 weeks gestation and use thyroid hormones as treatment instead of prophylaxis.

Developmental Disabilities↗
PubMed1988

Diabetic retinopathy after two years of intensified insulin treatment. Follow-up of the Kroc Collaborative Study. The Kroc Collaborative Study Group.

The progression of retinopathy was reevaluated at two years in 64 of the 68 patients with mild to moderate diabetic retinopathy, originally randomly assigned for an eight-month period either to intensified diabetic control with continuous subcutaneous insulin infusion (CSII) or to unchanged conventional injection treatment. Twenty-three of the 34 patients in the former group and 24 of the 34 in the latter agreed to continue to follow their original treatment assignment for a further 16 months. The others crossed over at the end of the first eight months of the study. During those first eight months, substantial lowering of blood glucose concentration had been achieved in the CSII group, unexpectedly associated with evidence of accelerated progression of retinopathy compared with the conventional injection treatment group. Glycemic separation was maintained at two years between the two groups continuing to receive the assigned treatment; during this time the mean retinopathy level deteriorated with conventional injection treatment and improved with CSII. At two years the degree of retinopathy in the two treatment groups was indistinguishable, with some trend to lesser overall deterioration with CSII. It is concluded that, in diabetics with mild to moderate nonproliferative retinopathy, the acceleration in activity associated with tightened control is not sustained and does not initiate vasoproliferative deterioration in retinopathy.

Blood Glucose↗
PubMed2006

Crossing boundaries: implementing an interprofessional module into uniprofessional Bachelor programmes.

In accordance with the curriculum reforms within health education in Norway, the Faculty of Health Sciences at Oslo University College introduced in 1998 an interprofessional module, entitled "VEKS", for eight different professional programmes. A shared module of 30 credits (15 for technically oriented programmes) was introduced into the three-year programmes. A problem-based and project-oriented format was chosen as the teaching and learning model to enhance the interactive, experiential and collaborative learning. This paper describes experience gained during the five-year implementation period. Empirical data were collected through participatory observations, students' and tutors' evaluations and group interviews with tutors and faculty leaders. The innovative project described challenged traditional educational boundaries and structures, frames of thought and habits. It broadened perspectives within the particular professional programmes as well as preparing students for their future professional careers. Lessons learned can be summed up as: Time, resources and a certain staff consensus are needed to deal with and overcome traditions and attitudes, the students' learning is a socialization process which needs to be developed over time; intermittent interprofessional interventions during the three-year period was found to be inadequate, and the tutor role is essential in order to support the students' learning process.

Cooperative Behavior↗
PubMed2000

Hepatitis A immunoglobulin: an international collaborative study to establish the second international standard.

A collaborative study was carried out to assess the suitability of a candidate replacement material for the International Standard for hepatitis A immunoglobulin, which was found to be reactive for HCV RNA, and to calibrate it in International Units. The candidate standard, coded 97/646, was derived from a bulk of 16% immunoglobulin supplied by the Central Laboratory of the Netherlands Red Cross, Amsterdam, and diluted 1 in 2 in H2O resulting in a final immunoglobulin concentration of 8%. Sixteen laboratories from 11 countries participated in the study and contributed data from 64 assays performed using six commercial assay kits and four in-house methods. All assays were analysed as parallel line bioassays comparing assay response with log concentration. The overall mean potency of the candidate replacement immunoglobulin standard, 97/646, relative to the International Standard for hepatitis A immunoglobulin, was 98.6 IU/ml. A freeze-dried serum preparation, 97/648, was also calibrated in this study and had a potency of 22.64 IU/ml. The Second International Standard for hepatitis A immunoglobulin, human, was established by the World Health Organisation Expert Committee on Biological Standardisation in 1998 with a potency of 49 IU per ampoule when reconstituted in 0.5 ml.

Biological Assay↗
PubMed2004

Local cultural knowledge and water resource management: the Wind River Indian Reservation.

Ecology and culture comprise interacting components of landscapes. Understanding the integrative nature of the landscape is essential to establish methods for sustainable management. This research takes as a unifying theme the idea that ecological and cultural issues can be incorporated through management. As a first step in developing integrative management strategies, information must be collected that compares and contrasts ecological and cultural issues to identify their areas of intersection. Specifically how can local cultural knowledge enable water resource management that reflects cultural and ecological values? This research examines Native American cultural knowledge for setting water resource management priorities in the Wind River Indian Reservation in central Wyoming. A cross-cultural approach is adopted to assess the relationship between indigenous cultural knowledge and Euro-American perspectives through a comparative examination of the Wind River Water Code and Wyoming Water Law. This research indicates that cultural perspectives provide a rich arena in which to examine management issues. Understanding and identifying cultural practices may be an important first step in collaborative resource management between different cultural groups to prevent conflict and lengthy resolution in court.

Conflict, Psychological↗
PubMed1994

Development of standard measurement methods for essential properties of ultrasound therapy equipment.

In a European collaborative project, partly funded by the EC Community Bureau of Reference (BCR), reliable methods of measurement for characterising the output and performance of ultrasound physiotherapy equipment have been developed. Experimental investigations using miniature hydrophones to scan the distribution of pressure in therapeutic fields have been undertaken in combination with theoretical simulations of the sound fields. Important parameters such as Beam Cross Sectional Area (BCSA), Effective Radiating Area (ERA) and Beam Nonuniformity Ratio (BNR) (characterising "Hot-spots": potentially harmful to patients) have been redefined, and these new definitions have been incorporated in a revision of IEC 150:1963. The reproducibility and accuracy of measurements of ERA based on these procedures are presented in detail for a variety of therapy fields. Furthermore, it is shown that the value of the BNR for any treatment head should not exceed 8. Values of effective intensity derived using the new procedures are shown to be significantly higher than those obtained using FDA (USA) definitions, a conclusion in agreement with the theoretical expectations. Measurements on four treatment heads were used to validate the procedures of the proposed revised standard. Values of ERA derived by the two laboratories were in agreement to within 2.5%.

Computer Simulation↗
PubMed2000

WKHA rats with genetic hyperactivity and hyperreactivity to stress: a review.

WKHA rats are a homozygous strain of hyperactive rats developed by successive selected inbreedings, starting from a cross of spontaneously hypertensive (SHR) rats with their normotensive control strain, WKY. WKHA express hyperactivity in a novel environment, as do SHRs, however their blood pressure is normotensive, thus they are potentially a more promising model of hyperactivity than the SHR. WKHA became homozygous in 1990 (20 strict brother/sister inbreedings), and they are currently in the F36 generation. Studies in collaboration with numerous colleagues have allowed us to describe a limited behavioral and neurochemical profile of WKHA rats. Their most prominent behaviors include hyperactivity in a novel environment, and a marked hyperreactivity to stress, both of which are also characteristic of SHRs. They differ from SHRs in other respects: WKHA are less aggressive, habituate more readily to a novel environment, and are less exploratory in a familiar environment than the SHR. Neurochemical studies have revealed changes in brain monoamine function in WKHA rats, particularly in frontal cortical norepinephrine and dopamine uptake, and they show marked changes in neuroendocrine responses in the hypothalamic/pituitary/adrenal axis, as well as altered POMC peptides in the pituitary anterior and posterior lobes. Molecular genetic studies by colleagues in Bordeaux have identified a quantitative trait locus for the hyperactivity/hyperreactivity trait of WKHA rats.

Animals↗
PubMed2006

Comparison of alternative models for personality disorders.

BACKGROUND: The categorical classification system for personality disorder (PD) has been frequently criticized and several alternative dimensional models have been proposed. METHOD: Antecedent, concurrent and predictive markers of construct validity were examined for three models of PDs: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP) model and the DSM-IV in the Collaborative Study of Personality Disorders (CLPS) sample. RESULTS: All models showed substantial validity across a variety of marker variables over time. Dimensional models (including dimensionalized DSM-IV) consistently outperformed the conventional categorical diagnosis in predicting external variables, such as subsequent suicidal gestures and hospitalizations. FFM facets failed to improve upon the validity of higher-order factors upon cross-validation. Data demonstrated the importance of both stable trait and dynamic psychopathological influences in predicting external criteria over time. CONCLUSIONS: The results support a dimensional representation of PDs that assesses both stable traits and dynamic processes.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2001

Negotiating the informed-consent process in developing countries: a comparison of Swaziland and Pakistan.

Protecting the rights of research participants when conducting studies within an international context presents many challenges. The purpose of this article was to compare and contrast the process of obtaining informed consent in two very different countries - Swaziland and Pakistan. Major aspects of the informed-consent process presented included identification of gatekeepers, seeking permission from officials, negotiating with these officials and Institutional Review Board (IRB) committees in regard to the type of data to be collected, and explaining informed consent to participants in the field. Data for this article is based upon qualitative research of collaboration between nurses and healers in Swaziland and from a variety of studies completed in Pakistan. These studies demonstrate the inadequacy and complexity of applying western-based concepts of informed consent to developing countries.

Cross-Cultural Comparison↗
PubMed2006

Not just another multi-professional course! Part 1. Rationale for a transformative curriculum.

Undergraduate inter- and multi-professional education has traditionally aimed to develop health professionals who are able to collaborate effectively in comprehensive healthcare delivery. The respective professions learn from and about each other through comparisons of roles, responsibilities, powers, duties and perspectives in order to promote integrated service. Described here is the educational rationale of a multi-professional course with a difference; one that injects value to undergraduate health professional education through the development of critical cross-field knowledge, skills and attitudes that unite rather than differentiate professions. The aim of this course, offered at the Faculty of Health Sciences, University of Cape Town, is to lay an integrated, pan-professional foundation for the advancement of collective commitment to and understanding of national health and social development objectives such as primary health care, human rights and professionalism. Pan-professional refers to curriculum content that is core and of critical relevance to all participating professions. What is learned, how it is learned, how learning is facilitated and how it is applied, has been co-constructed by a multi-professional design team representing a range of health professions (audiology, medicine, occupational therapy, nursing, physiotherapy and speech therapy) and academic disciplines (anthropology, sociology, psychology, history, African studies and social development, information technology and language literacy). Education specialists facilitate the ongoing design process ensuring that the structure and content of the curriculum complies with contemporary adult learning principles and national higher education imperatives. Designing the original curriculum required the deconstruction of intra-professional and disciplinary canons of knowledge and ways of 'doing things' in order to identify and develop shared interpretations of critical epistemology and axiology for health professional practice in the South African context. This enabled the alignment of the learning objectives, at first year level, of all the represented professions. The educational rationale guiding the curriculum design process is discussed in Part 1 of two articles. Part 2 describes the 'nuts and bolts' or practicalities of the curriculum design process.

Curriculum↗