*Background: Modern medical care increasingly requires coordinated teamwork and communication between healthcare professionals of different disciplines. Unfortunately, healthcare professional students are rarely afforded the opportunity to learn effective methods of interprofessional (IP) communication and teamwork strategies during their education. The question of how to best incorporate IP interactions in the curricula of the schools of health professions remains unanswered. Objective: We aim to solve the lack of IP education in the pharmacy curricula through the use of high fidelity simulation (HFS) to allow teams of medical, pharmacy, nursing, physician assistant, and social work students to work together in a controlled environment to solve cases of complex medical and social issues. Methods: Once weekly for a 4-week time period, students worked together to complete complex simulation scenarios in small IP teams consisting of pharmacy, medical, nursing, social work, and physician assistant students. Student perception of the use of HFS was evaluated by a survey given at the conclusion of the HFS sessions. Team communication was evaluated through the use of Communication and Teamwork Skills (CATS) Assessment by 2 independent evaluators external to the project. Results: The CATS scores improved from the HFS sessions 1 to 2 (p = 0.01), 2 to 3 (p = 0.035), and overall from 1 to 4 (p = 0.001). The inter-rater reliability between evaluators was high (0.85, 95% CI 0.71, 0.99). Students perceived the HFS improved: their ability to communicate with other professionals (median =4); confidence in patient care in an IP team (median=4 student interest in IP work (median=4.5), and was an efficient use of student time (median=4.5) Conclusion: The use of HFS improved student teamwork and communication and was an accepted teaching modality. This method of exposing students of the health sciences to IP care should be incorporated throughout the curricula.
Boxed warning nonadherence is a concern in the inpatient setting, specifically with NSAID use in general medicine patients and antipsychotic use in ICU patients. More than half of boxed warning nonadherence occurred in medications restarted from home, which emphasizes the need for medication evaluation during transitions of care.
NOTES P35 cmxom G273 .'I Acid degradation of flavonoids as an aid in their identification In the course of previous studies of constituents from L.&x needlesl~ 2, small quantities of flavonol glycosides were hydrolysed according to standard procedure&a in ethanolic or aqueous HCl. In many cases, especially when very low concentrations were used, partial or complete degradation of the aglycone occurred, even when the time of hydrolysis was restricted to 5 min. Autosidation of flavonols under acid conditions, leading to a benzoic acid, phloroglucinol (phloroglucinol carbosylic acid) and carbon monoxide, has been describedb-7. The rate of autoxidation in I iV WC1 at IOO o given, however, is much lower than that found in our experiments, This is probably due to the concentration used; higher concentrations of the flavonol glycosides produced under similar conditions a reasonable yield of the aglycone. Knowing the effect of autosidation, it may either be prevented by working under an inert atmosphere (nitrogen) or it may be used as a method of identification of the aglycone. In several cases, identification of the benzoic acid(s) obtained from acid degradation provided useful information on the purity and identity of the corresponding aglycone. The glycosides of isorhamnetin and syringetin, for example, proved difficult to separates** and the aglycones differ only in their RF in phenol3. One of the compounds, isolated in low quantity from needles of Larix Zaricina, WCI.S identified as isorhamnetin-3-glucoside by chromatographic and spectral studies. Among the products of acid degradation, however, vanillic acid, as well as syringic acid was found, indicating the presence of a syringetin glycoside; this was later isolated and identified as syringetin-3-glucoside. Obviously, even in phenol, iso-rhamnetin and syringetin were kept at the same spot with RF similar to that of the reference isorhamnetin. Acid degradation followed by identification of the benzoic acid residue(s) has now been introduced as a standard procedure in our laboratory. Chromatography on paper with benzene-acetic acid-water (125 : 72 : 3) proved very useful in this connection, because this solvent system separates both the benzoic acids and the flavonols well, and at the same time indicates the number of hydroxyl groups"gxa. Of course, a similar effect can be obtained by alkaline degradation. Acidic procedures, however, often provide information on the original aglycone, the benzoic acid produced and the sugar residues, and therefore seem much more suited for work on very small samples.
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