Browsing IHR Institute for Health Research by Publisher "Informa Healthcare"
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Medical and nursing students attitudes towards interprofessional education in NepalIn order to elicit the attitudes of final year medical and 3rd year undergraduate nursing students, towards interprofessional education (IPE), a survey using a 25-item questionnaire and a five-point Likert scale design was administered to a convenience sample of 60 students. In addition, two focus group discussions were carried out, one in each student group, using a topic guide. The findings suggest that the majority of the students were aware about the concept and importance of IPE. The learning reported by participants reflected two main issues: participants emphasized firstly the importance of communication skills, both with other professionals and with patients, and secondly the development of increased awareness of others' roles. Research has demonstrated the importance of learning together as well as learning from and about different professionals within the context of a shared learning experience. Respondents should undertake appropriate skills development in IPE and be provided with knowledge and experience to ensure that they are adequately equipped to work with or learn from one another.
Muscle atrophy and metal-on-metal hip implantsBackground and purpose — Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. Patients and methods — We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. Results — The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Interpretation — Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs.