Interprofessional Education in Anatomy: Learning Together in Medical and Nursing Training

Teamwork and the interprofessional collaboration of all health professions are a guarantee of patient safety and highly qualified treatment in patient care. In the daily clinical routine, physicians and nurses must work together, but the education of the different health professions occurs separately in various places, mostly without interrelated contact. Such training abets mutual misunderstanding and cements professional protectionism, which is why interprofessional education can play an important role in dismantling such barriers to future cooperation. In this article, a pilot project in interprofessional education involving both medical and nursing students is presented, and the concept and the course of training are described in detail. The report illustrates how nursing topics and anatomy lectures can be combined for interprofessional learning in an early phase of training. Evaluation of the course showed that the students were highly satisfied with the collaborative training and believed interprofessional education (IPE) to be an important experience for their future profession and understanding of other health professionals. The results show that the IPE teaching concept, which combines anatomy and nursing topics, provides an optimal setting for learning together and helps nurses and doctors in training to gain knowledge about other health professionals’ roles, thus evolving mutual understanding.

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among Swiss veterinary health care providers: detection of livestock- and healthcare-associated clones.

We screened a total of 340 veterinarians (including general practitioners, small animal practitioners, large animal practitioners, veterinarians working in different veterinary services or industry), and 29 veterinary assistants for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP) at the 2012 Swiss veterinary annual meeting. MRSA isolates (n = 14) were detected in 3.8 % (95 % CI 2.1 - 6.3 %) of the participants whereas MRSP was not detected. Large animal practitioners were carriers of livestock-associated MRSA (LA-MRSA) ST398-t011-V (n = 2), ST398-t011-IV (n = 4), and ST398-t034-V (n = 1). On the other hand, participants working with small animals harbored human healthcare-associated MRSA (HCA-MRSA) which belonged to epidemic lineages ST225-t003-II (n = 2), ST225-t014-II (n = 1), ST5-t002-II (n = 2), ST5-t283-IV (n = 1), and ST88-t186-IV (n = 1). HCA-MRSA harbored virulence factors such as enterotoxins, β-hemolysin converting phage and leukocidins. None of the MRSA isolates carried Panton-Valentine leukocidin (PVL). In addition to the methicillin resistance gene mecA, LA-MRSA ST398 isolates generally contained additional antibiotic resistance genes conferring resistance to tetracycline [tet(M) and tet(K)], trimethoprim [dfrK, dfrG], and the aminoglycosides gentamicin and kanamycin [aac(6')-Ie - aph(2')-Ia]. On the other hand, HCA-MRSA ST5 and ST225 mainly contained genes conferring resistance to the macrolide, lincosamide and streptogramin B antibiotics [erm(A)], to spectinomycin [ant(9)-Ia], amikacin and tobramycin [ant(4')-Ia], and to fluoroquinolones [amino acid substitutions in GrlA (S84L) and GyrA (S80F and S81P)]. MRSA carriage may represent an occupational risk and veterinarians should be aware of possible MRSA colonization and potential for developing infection or for transmitting these strains. Professional exposure to animals should be reported upon hospitalization and before medical intervention to allow for preventive measures. Infection prevention measures are also indicated in veterinary medicine to avoid MRSA transmission between humans and animals, and to limit the spread of MRSA both in the community, and to animal and human hospitals.

Outbreak of Morel's disease in a Swiss goat flock

Staphylococcus aureus subsp. anaerobius is the causative agent of Morel’s disease in goats and sheep. We report the first outbreak of Morel’s disease in a Swiss goat flock. Multilocus sequence typing revealed that the Swiss isolates belong to sequence type (ST)1464, which is the ST responsible for outbreaks worldwide.

Evolution of methicillin-resistant Staphylococcus aureus (MRSA)

In 2009, a monitoring survey on the prevalence and genetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) in slaughter pigs in Switzerland was started and revealed the presence of an unusual Multi Locus Sequence Type (ST49), which was detected for the first time in slaughter pigs worldwide. In addition to ST49, pigs also harboured ST398 and ST1. The prevalence of MRSA in slaughter pigs in Switzerland increased from 2.0% (95%CI 0.9-3.9) in 2009 to 5.9% (95% CI 3.8-8.7) in 2010, and remained stable in 2011 with 5,6% (95% CI 3.6-8.4). The increase was mainly due to the spread of ST398-t034, whereas ST49 was less frequently detected in 2010 and 2011. The presence of a specific sequence type (ST49) in MRSA from Switzerland suggests that it has been selected in local pig husbandry. However, MRSA of this lineage seems to have a lower potential for dissemination than ST398, which is increasingly detected in Swissslaughter pigs.

From Framework to Action: The DESIRE Approach to Combat Desertification

It has become increasingly clear that desertification can only be tackled through a multi-disciplinary approach that not only involves scientists but also stakeholders. In the DESIRE project such an approach was taken. As a first step, a conceptual framework was developed in which the factors and processes that may lead to land degradation and desertification were described. Many of these factors do not work independently, but can reinforce or weaken one another, and to illustrate these relationships sustainable management and policy feedback loops were included. This conceptual framework can be applied globally, but can also be made site-specific to take into account that each study site has a unique combination of bio-physical, socio-economic and political conditions. Once the conceptual framework was defined, a methodological framework was developed in which the methodological steps taken in the DESIRE approach were listed and their logic and sequence were explained. The last step was to develop a concrete working plan to put the project into action, involving stakeholders throughout the process. This series of steps, in full or in part, offers explicit guidance for other organizations or projects that aim to reduce land degradation and desertification.

Bereitschaft zu Interprofessionellem Lernen bei Studierenden der Medizin und der Pflege

Fragestellung/Einleitung An der Universität Bern haben die Medizinstudierenden des 1. und 2. Jahres die Möglichkeit mit Pflegestudierenden zusammen ein Wahlpraktikum zu bestreiten. Hierbei stellen sich die Studierenden gegenseitig ihre Curricula vor und verbringen gemeinsam je einen Halbtag in beiden Bildungseinrichtungen. Mit dem RIPLS (readiness for Interprofessional learning scale) wollten wir die Bereitschaft der Studierenden vor und nach dem Wahlpraktikum erfassen und diese mit je einer Kontrollgruppe der beiden Studiengänge vergleichen. Methoden Als Messinstrument wählten wir die Readiness for Interprofessional Learning Scale (RIPLS). Da noch keine validierte deutsche Übersetzung der RIPLS existiert, haben wir die 19 items zu zweit übersetzt und mehrfach überarbeitet. Am Wahlpraktikum nahmen 15 Medizin- und 11 Pflegestudierende teil. Die Kontrollgruppen bestanden aus 34 Medizin- und 21 Pflegestudierenden. Die RIPLS wurden vor und unmittelbar nach dem Wahlpraktikum verteilt und eingesammelt. Ergebnisse Die Resultate der Befragung zeigen, dass sich die Antworten der Medizin- und Pflegestudierenden in der Tendenz sehr ähnlich sind. In der Regel sind alle inklusive die beiden Kontrollgruppen positiv zum interprofessionellen Lernen eingestellt. Nur bei einzelnen Items, die das Rollenverständnis der beiden Berufsgruppen betreffen, waren grössere Unterschiede erkennbar. Die Antworten vor und nach dem Wahlpraktikum unterscheiden sich nicht wesentlich. Diskussion/Schlussfolgerung Sowohl Medizin- als auch Pflegestudierende haben eine positive Haltung gegenüber interprofessionellen Lernen, unabhängig davon, ob sie sich für eine entsprechendes Wahlpraktikum gemeldet haben oder nicht. Die Teilnahme am Wahlpraktikum verändert diese Haltung jedoch nicht wesentlich. Dies kontrastiert mit den sehr positiven spontanen Rückmeldungen der Studierenden beider Studiengänge. Es stellt sich darum die Frage, ob die RIPLS das geeignete Messinstrument ist, um die Effekte eines interprofessionellen Wahlpraktikus zu erfassen. Literaturhinweise: [1] Parsell G, Bligh J. The development of a questionnaire to assess the readiness of health care students for interprofessional learning (RIPLS). Med Educ. 1999 Feb;33(2):95-100 [2] Solomon P, Salfi J. Evaluation of an interprofessional education communication skills initiative. Educ Health (Abingdon). 2011 Aug;24(2):616. Epub 2011 Jul 30.

How much management is enough? Stakeholder views on forest management in fire-prone areas in central Portugal

With the increasing pressure to improve the contribution of forests to help dealing with global changes, it is critical to understand the different perceptions of those involved in the forest. How do forest owners, managers and members of local communities who often depend on the forest, value it and what are the problems affecting the forests in terms of being able to meet these new challenges? In Portugal, this task has taken on an even greater priority as more than 90% of the forest is private and forest management relies on the individual decisions of thousands of forest owners. To understand stakeholder views on forest and forest management, a transversal social perception survey was implemented in the form of a case study of central Portugal which included decision-makers, local technicians, forest owners and the general public. The results show that there is a consensus on the main issues affecting forests and forest management. A shift from classic forest owners to the emergence of indifferent forest owners was observed, although this shift has not been recognized by the forest owners in the survey, who maintain the individual management of their properties.