bluuebunny/crossref_metadata_2025 huggingface dataset:
Indicators for Detection of Septic Arthritis in the Acutely Swollen Joint Cohort of Those Without Joint Prostheses
Authors: Roberts John , Schaefer Eric , Gallo Robert A.
Published: February 2014

Differentiating septic arthritis from culture-negative, acute atraumatic joint effusion is difficult. Studies have attempted to elucidate factors that herald infection, but, due to overlap, most conclude that the diagnosis ultimately relies on clinical judgment. Furthermore, studies are limited by broad inclusion criteria. The current retrospective case study sought to examine (1) which markers differentiate a culture-positive septic joint from culture-negative effusion in patients suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint and (2) whether threshold values of these markers exist that predict septic arthritis. The study was performed by reviewing records of those who underwent operative irrigation and debridement involving the shoulder, elbow, wrist, hip, knee, and ankle. Patients were included if they were older than 18 years and had an acutely swollen/painful joint and no organisms on initial Gram stain. Exclusion criteria were lack of serum markers or synovial fluid aspirate, antibiotics within 1 week, adjacent wound or skin infection, recent trauma to the joint, and previous joint infection or surgery to the joint. Several clinical, serological, and synovial parameters were collected and analyzed using paired
t
test with Bonferonni correction. Serum C-reactive protein was the only significantly different variable between groups. Serum C-reactive protein greater than 10.5 mg/dL was predictive of infection. In those suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint, C-reactive protein greater than 10.5 mg/dL is suspicious for joint sepsis and should warrant consideration for urgent irrigation and debridement.
First Metatarsophalangeal Joint Arthrodesis for the Treatment of Tophaceous Gouty Arthritis
Authors: Kim Yong Sang , Park Eui Hyun , Lee Ho Jin , Koh Yong Gon
Published: February 2014

In tophaceous gouty arthritis, surgeons face the choice between preservation of the involved joint and arthrodesis after tophi excision. Magnetic resonance imaging (MRI) can allow evaluation of the distribution of tophaceous deposits, which can be difficult to visualize on radiography. The goal of this study was to evaluate the characteristic MRI features of tophaceous lesions and to compare the clinical outcomes of arthrodesis after tophi excision with those of simple tophi excision. The authors reviewed 16 feet in 15 consecutive patients diagnosed with tophaceous gouty arthritis of the first metatarsophalangeal (MTP) joint who underwent surgery. Nine feet (group A) were treated with simple tophi excision, whereas the other 7 (group B) underwent first MTP joint arthrodesis after tophi excision. For clinical evaluation, the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale, and patient satisfaction assessments were used. Magnetic resonance imaging was performed to evaluate the characteristics of tophaceous deposits in the first MTP joint. Mean VAS and AOFAS scores and patient satisfaction significantly differed between the 2 groups at final follow-up (
P
=.007, .005, and .002, respectively). In group A, progression of arthritis of the first MTP joint was observed in 6 of 9 cases at final follow-up. The tophaceous lesions of these 6 cases were found to be located intra-articularly on MRI. Arthrodesis after tophi excision should be considered for treating tophaceous gouty arthritis of the first MTP joint when tophi are located intra-articularly and loss of cartilage involved is greater than 50% of the entire joint.
Efficacy of Delayed Decompression of Lumbar Disk Herniation Causing Cauda Equina Syndrome
Authors: Aly Tarek A. , AboRamadan Mohamed Osama
Published: February 2014

Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency that can have devastating long-lasting neurologic consequences. Compression of the cauda equina can result in paralysis of bowel and bladder function. Such compression has been considered the only absolute indication for surgery in cases of lumbar disk disease. Therefore, it is extremely important that physicians be aware of the condition so that a surgeon is consulted before neurological damage becomes permanent. This article reports the results of delayed surgical decompression in cases of lumbar disk herniation with CES.

The study group comprised 14 patients (11 men and 3 women) with a mean age of 48 years (range, 36–57 years). Clinical presentation was chronic low back pain, sciatica, and impaired sphincter function. All patients had a fenestration at the affected level and site, and the disk fragments were excised and the disk space cleared. The surgeries were performed 1 to 3 months after onset of sphinctric disturbance. Postoperatively, all patients were relieved of back and/or leg pain and showed sensory improvement. Twelve patients regained full control of urination and defecation. Lower extremity strength improved in 9 patients.

The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected.
Biomechanical Comparison of Volar Locked Plate Constructs Using Smooth and Threaded Locking Pegs
Authors: Yao Jeffrey , Park Min Jung , Patel Chirag S.
Published: February 2014

The goal of this study was to determine whether there is any biomechanical difference in terms of construct strength with axial loading between volar fixed-angle locking plates with threaded locking vs smooth locking pegs. The control group comprised 7 cadaveric specimens with threaded locking pegs, and the test group comprised 7 cadaveric specimens from the same donor with smooth locking pegs. The DVR plate (Biomet, Warsaw, Indiana) was applied to the volar surface. A 15-mm dorsal wedge osteotomy was created near the level of Lister’s tubercle. The radii were potted in polymethylmethacrylate for biomechanical testing. The loading protocol consisted of 3 parts: ramp loading, cyclic loading, and failure loading. The outcome measures of stiffness and failure were used to test the plates fixed with threaded and smooth locking pegs. When comparing each cycle, the difference in mean stiffness between threaded and smooth locking pegs was as follows: 122 N/mm, −9.09 N/mm, −14.7 N/mm, 49.4 N/mm, 57.4 N/mm, 71.9 N/mm, 52.3 N/mm, 35.8 N/mm. The difference in mean failure load between the threaded and smooth locking pegs was −11.3 N. There was no difference in stiffness throughout all cycles. Failure analysis showed no significant difference between the smooth (962 N) and threaded (951 N) locking pegs. The difference in stiffness between the 2 constructs (smooth minus threaded locking pegs) in ramp loading ranged from −122 to 15 N/mm. The results of this study showed no significant differences in stiffness and failure load between constructs consisting of threaded locking pegs or smooth locking pegs in the distal rows of the DVR distal radius volar locking plate. Based on the results of this study, there may be no benefit to using threaded locking pegs vs smooth locking pegs when treating distal radius fractures with a volar locking plate.
Seasonality of Infection Rates After Total Joint Arthroplasty
Authors: Kane Patrick , Chen Christopher , Post Zachary , Radcliff Kris , Orozco Fabio , Ong Alvin
Published: February 2014

The correlation between season (fall, winter, spring, and summer) and infection rate in surgical patients is well defined in many specialties. To the authors’ knowledge, there are no data in the literature on this phenomenon in patients undergoing total joint arthroplasty. They hypothesized that there would be an increased infection rate in the summer months in patients undergoing elective total joint arthroplasty. They retrospectively reviewed consecutive patients undergoing elective total hip or knee arthroplasty at a single institution during 1 year by a single surgeon. Wound infections were defined as any patient requiring oral antibiotics for cellulitis, readmission for intravenous antibiotics, a return to the operating room for irrigation and debridement, or excisional arthroplasty and placement of a cement spacer within 90 days of the initial procedure. Seventeen of 750 patients developed an infection, for an overall incidence of 2.2%. There was a statistically significant difference in infection rate according to season: 3 (1.5%) infections occurred in winter, 1 (0.5%) in spring, 9 (4.7%) in summer, and 4 (2.4%) in fall. The incidence was highest during July (4.5%), August (5.4%), and September (4.3%). There was a statistically significant difference in infection rate between summer/fall (3.6%) vs winter/spring (1.0%). There is an increase in the incidence of infection during summer months for patients undergoing total joint arthroplasty. The authors recommend increased surveillance and more thorough preoperative sterilization procedures during these warmer months.
Proximal Femoral Reconstruction With a Constrained Acetabulum in Oncologic Patients
Authors: Jawad Muhammad Umar , Brien Earl W.
Published: February 2014

Metallic endoprostheses are used for oncological reconstruction around the proximal femur and hip joint. Common modes of failure with hemiarthroplasty or standard hip arthroplasty after proximal femoral replacement include dislocation, late hip pain, and infection. The authors reviewed hospital records to identify patients undergoing constrained tripolar hip arthroplasty for oncological reasons between 2002 and 2012. Inclusion criterion was at least 12-cm proximal femoral resection, including patients with total femur reconstruction. A total of 33 patients were reviewed. Information regarding demographics, length of follow-up, treatment characteristics, and patient outcomes was extracted. Average follow-up for all patients was 912.33 days (30.4 months). Average follow-up was 1396.1 days for living patients and 428.6 days for deceased patients. Average estimated blood loss was 462.12 cc: an average of 1080 cc for patients undergoing total femoral resection and replacement and 315.8 cc for patients undergoing proximal femoral resection and replacement. Average operative time was 137.7 minutes: an average of 205 minutes for patients undergoing total femoral resection and replacement and 119.1 minutes for patients undergoing proximal femoral resection and replacement. Average Musculoskeletal Tumor Society score was 21.7. There were no dislocations in the cohort. A constrained tripolar device can be safely used for oncological proximal femoral reconstructions while minimizing the risk of dislocation. Positioning of the acetabular implant in neutral anatomic version in conjunction with a neutral-placed femoral component provides the greatest range of motion, reduction of liner impingement, and improved hip stability.
Ankylosing Spondylitis in an Athlete With Chronic Sacroiliac Joint Pain
Authors: Miller Timothy L. , Cass Nathan , Siegel Courtney
Published: February 2014

Ankylosing spondylitis is a disease in which inflammation of joints, most often in the axial skeleton, can lead to reactive fibrosis and eventual joint fusion with associated immobility and kyphosis. The disease often involves extra-articular features, such as uveitis and aortic regurgitation, as well as associated inflammatory conditions of the intestines. Its etiology is unknown. Ankylosing spondylitis most commonly presents in young males (15–30 years old) as persistent low back pain and stiffness that is worse in the morning and at night and improves with activity. The authors report the case of a young male athlete whose symptoms were initially incorrectly diagnosed as sacroiliac joint instability and dysfunction and later as a sacroiliac stress fracture before further workup revealed a seronegative spondyloarthropathy and the diagnosis of ankylosing spondylitis. The patient was prescribed oral indomethacin daily by the attending rheumatologist and started on a slow progression of return to running, jumping, and weight lifting. Within 4 weeks of beginning this treatment, the patient had complete cessation of pain with the medication. At follow-up 1 year after graduation from his university, the patient was nearly symptom free and working in a non-heavy labor job. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition.
Professional Writing in Nursing Education: Creating an Academic–Community Writing Center
Authors: Latham Christine L. , Ahern Nancy
Published: February 2014

Contemporary professional nursing requires competency in both oral and written communication. Outside of writing for publication, instructional methods to teach professional writing in baccalaureate nursing programs are not well documented in the literature. The need for professional writing, coupled with the need to diversify the workforce with students from varying ethnic and educational backgrounds, creates some additional challenges to meet programmatic requirements for scholarly, evidence-based writing outcomes. As two new prelicensure programs were initiated, a comprehensive assessment was conducted that included student focus groups and writing assessment tools to assess writing quality and student support needs. As a result of these data, faculty implemented curricular and instructional revisions and created a writing center that was staffed by older adult volunteers who had careers in writing. The processes, tools, and preliminary outcomes of these faculty-initiated changes to improve student support for writing are presented. [
J Nurs Educ.
2013;52(11):615–620.]
Comparison of Second-Degree and Traditional Undergraduate Nursing Students' Sense of Belonging During Clinical Placements
Authors: Sedgwick Monique
Published: February 2014

Second-degree undergraduate nursing programs are proliferating throughout Canada. Although these shorter programs are attracting students from a variety of disciplines and professions, a sense of belonging and the meaning or implications of belongingness have not been examined for this unique nursing student cohort. A survey design, using the Belongingness Scale–Clinical Placement Experience questionnaire, explores second-degree nursing students' sense of belonging, compared with that of 4-year undergraduate nursing students. Overall, second-degree nursing students experienced a sense of belonging during clinical placements to a lesser degree than their counterparts in a traditional nursing program. Providing second-degree students with opportunities to know and create partnerships with nurse educators and staff while on placements, as well as providing them with feedback presented in positive terms, will help these students flourish and engender a greater sense of belonging. [
J Nurs Educ
. 2013;52(11):657–661.]
Evaluating Dedicated Education Units for Clinical Education Quality
Authors: Mulready-Shick JoAnn , Flanagan Kathleen M. , Banister Gaurdia E. , Mylott Laura , Curtin Linda J.
Published: February 2014

Dedicated education units (DEUs) have emerged as an important clinical education innovation within academic practice partnerships. However, rigorous evaluation has not been conducted previously. This article presents findings from a randomized, controlled, multiyear, multisite study comparing the clinical education quality for students educated in either the DEU innovation or traditional clinical education model within the same nursing course. The evaluation occurred within a larger study focusing on teaching capacity, faculty work life, and educational quality at one large, urban university collaborating with three agency partners. To examine learning outcomes, the question posed was, “In what ways, if any, does the DEU intervention, when compared to traditional clinical education, enhance educational quality?” Results indicate that educational quality and learning gains are significantly more positive for students clinically instructed in DEUs. Findings will be of interest to education and practice leaders seeking to enhance the quality of clinical teaching, learning, and nursing practice. [
J Nurs Educ
. 2013;52(11):606–614.]
Physiological Differences During Decision Making Between Experienced Nurses and Nursing Students: A Pilot Study
Authors: Payne Leslie Karns
Published: February 2014

The purpose of this quasi-experimental pilot study was to explore the difference in sympathetic activity between groups of experienced nurses and nursing students during a clinical scenario. Eleven female, senior-level nursing students and 10 female nurses with more than 5 years of nursing experience participated in a computer-generated scenario, while simultaneously having their skin conductance recorded. Experienced nurses generated significantly more skin conductance responses than did the nursing students, and they had a higher score on the clinical scenario. The presence of a bodily signal was found to occur statistically more often in experienced nurses than in nursing students during clinical decision making, which has theoretical and practical implications for nurse educators who seek to aid students in developing sound decision making. [J Nurs Educ.2013;52(11):649–652.]
Interprofessional Education: A Survey of Students’ Collaborative Competency Outcomes
Authors: Baker Maureen J. , Durham Carol Fowler
Published: February 2014

This study examines students’ collaborative competencies after participating in an interprofessional education (IPE) course offered to undergraduates in nursing, medicine, and pharmacy. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was foundational to the course. The Interprofessional Collaborative Competency Attainment Survey was administered to 33 students who had successfully completed the interprofessional education course; 17 students completed the survey, for a response rate of 52%. The students’ collaborative competencies in the core areas of communication, collaboration, roles and responsibilities, collaborative patient- and family-centered approach, conflict management and resolution, and team functioning significantly improved (
n
= 17,
p
< 0.001) after course completion, compared with their collaborative competencies before the course. The findings suggest that students’ perceptions of their development of interprofessional and collaborative competencies significantly improved after course completion. This may influence their professional practice at the point of care and enhance patient safety. [
J Nurs Educ
. 2013;52(12):713–718.]
Wisdom: A Goal of Nursing Education
Authors: D’Antonio Jocelyn
Published: February 2014

The attainment of wisdom is a goal of intellectual development manifested in an individual by a solid knowledge base, effective critical thinking skills, creative problem solving, and a sense of duty and altruism to humankind. Promoting the achievement of wisdom as a focal point in a nursing program can provide a unifying perspective in the development of a curriculum. Teaching strategies such as case studies, small group discussions, mentoring, reflective writing, and professional networking are effective ways to promote wisdom in nursing students. [
J Nurs Educ
. 2014;53(2):105–107.]
Journey Toward Integration of Simulation in a Baccalaureate Nursing Curriculum
Authors: Masters Kathleen
Published: February 2014

Simulation is increasingly being used as a teaching strategy in nursing education. The best learning outcomes occur when simulation is integrated into the curriculum rather than added to a crowded curriculum. Faculty are challenged to integrate simulation experiences into the curriculum in a way that promotes optimal achievement of student learning objectives. The purpose of this article is to describe the journey toward the integration of simulation in a baccalaureate nursing curriculum. A description of the journey from the beginning, through Health Resources and Services Administration funding, as a participating site in The NCSBN National Simulation Study, and through curricular redesign are presented in the context of faculty growth and lessons learned. The ultimate purpose is to provide guidance to faculty teaching in nursing programs that may be struggling with some of the same issues that beleaguered faculty during our journey. [
J Nurs Educ
. 2014;53(2):102–104.]
International Academic Service Learning: Lessons Learned From Students’ Travel Experiences of Diverse Cultural and Health Care Practices in Morocco
Authors: Kaddoura Mahmoud , Puri Aditi , Dominick Christine A.
Published: February 2014

Academic service learning (ASL) is an active teaching–learning approach to engage students in meaningful hands-on activities to serve community-based needs. Nine health professions students from a private college and a private university in the northeastern United States volunteered to participate in an ASL trip to Morocco. The participants were interviewed to reflect on their experiences. This article discusses the lessons learned from students’ ASL experiences regarding integrating ASL into educational programs. The authors recommend a paradigm shift in nursing and dental hygiene curricula to appreciate diversity and promote cultural competency, multidisciplinary teamwork, and ethics-based education. [
J Nurs Educ
. 2014;53(1):45–47.]
Cultural Diversity Among Nursing Students: Reanalysis of the Cultural Awareness Scale
Authors: Rew Lynn , Becker Heather , Chontichachalalauk Jiraporn , Lee H.Y.
Published: February 2014

Nurses are educated to provide culturally competent care. Cultural competence begins with cultural awareness, a concept previously measured with the Cultural Awareness Scale (CAS). The purpose of this study was to reanalyze the CAS to determine construct validity and differences in cultural awareness among students of varying educational levels and experiences. The sample consisted of 150 nursing students (92% female, 33.6% racial minorities). Confirmatory factor analysis yielded three factors (CFI = 0.868, TLI = 0.854, RMSEA = 0.065, and SRMR = 0.086). Cronbach’s alpha ranged from 0.70 to 0.89. There were significant differences among educational levels, with lower division BSN students generally scoring higher than upper division and master’s of science in nursing students. Students who had taken courses on cultural diversity or global health generally outscored those who had not taken such courses. Findings support the validity of the CAS and its applicability to research studies of cultural awareness in nursing. [
J Nurs Educ.
2014;53(2):71–76.]
Undergraduate Peer-Assisted Learning in the Clinical Setting
Authors: Zentz Suzanne E. , Kurtz Christine P. , Alverson Elise M.
Published: February 2014

Peer-assisted learning was implemented at a private university. Senior nursing students were assigned to assist sophomores during their fundamentals clinical experience. The aim of this study was to evaluate the effectiveness of peer-assisted learning in the clinical setting and to ascertain students’ perceptions of fulfilling the roles of the professional nurse. During a 2-year period, 342 students participated in peer-assisted learning. Major outcomes identified by sophomores were reduced anxiety and increased confidence. A major benefit for seniors was reflection on their professional development, which strengthened their confidence and facilitated transition into the role of professional nurse. Future research should examine the impact of diversity and learning styles on this strategy and faculty perception of peer-assisted learning at achieving learning outcomes and relieving faculty burden. This study supports peer-assisted learning as an effective teaching strategy for learning nursing skills and implementing the roles of the professional nurse. [
J Nurs Educ
. 2014;53(3, Suppl.):S4–S10.]
A Descriptive Study of a Clinical Evaluation Tool and Process: Student and Faculty Perspectives
Authors: Krautscheid Lorretta , Moceri Joane , Stragnell Susan , Manthey Lisa , Neal Thea
Published: February 2014

Clinical evaluation tools are designed to assess nursing students’ knowledge, skills, and attitudes related to program and course outcomes and professional nursing standards. Students, faculty, administrators, and the public rely on the effectiveness of the tool and process to determine progression within the curriculum and validate competency. In May 2012, a revised clinical evaluation tool was implemented in a baccalaureate nursing program. This study was undertaken to evaluate the revised clinical evaluation tool by exploring the perspectives of students and faculty who use the tool and engage in the evaluation process. Findings revealed the tool was user friendly and instructions were clear, with sufficient grading criteria to determine clinical competency. Findings also revealed areas for improvement in the evaluation process, including orientation to the tool, connecting program outcomes to clinical performance, and meaningful participation in evaluation. Recommendations are made for improving the clinical evaluation process. [
J Nurs Educ
. 2014;53(3, Suppl.):S30–S33.]
Toward Creating an Optimal Acute Care Clinical Learning Environment: Insights From Staff, Faculty, and Students
Authors: Young Maria , Simpson Vicki , McComb Sara A. , Kirkpatrick Jane M. , La Lopa Joseph M. , Bullard Karen S.
Published: February 2014

Understanding how a clinical site impacts student learning was the focus for a participatory action research study in which three separate focus groups for students, faculty, and staff were convened. Participants were asked to identify what they enjoyed or liked about the clinical setting, what they disliked about the clinical setting, and what they would change about the clinical setting. Themes identified by a constant comparative method included experiences provided, attitudes, and expectations. Although the researchers anticipated that each group would have a unique and different perspective on the clinical experience, respondents were consistent in their beliefs both within and among groups. Of interest, each participant group attributed an ineffective clinical learning environment to external causes. [
J Nurs Educ
. 2014;53(3, Suppl.):S42–S45.]
Teaching Population Health and Community-Based Care Across Diverse Clinical Experiences: Integration of Conceptual Pillars and Constructivist Learning
Authors: Valentine-Maher Sarah K. , Van Dyk Elizabeth J. , Aktan Nadine M. , Bliss Julie Beshore
Published: February 2014

Nursing programs are challenged to prepare future nurses to provide care and affect determinants of health for individuals and populations. This article advances a pedagogical model for clinical education that builds concepts related to both population-level care and direct care in the community through a contextual learning approach. Because the conceptual pillars and hybrid constructivist approach allow for conceptual learning consistency across experiences, the model expands programmatic capacity to use diverse community clinical sites that accept only small numbers of students. The concept-based and hybrid constructivist learning approach is expected to contribute to the development of broad intellectual skills and lifelong learning. The pillar concepts include determinants of health and nursing care of population aggregates; direct care, based on evidence and best practices; appreciation of lived experience of health and illness; public health nursing roles and relationship to ethical and professional formation; and multidisciplinary collaboration. [
J Nurs Educ
. 2014;53(3, Suppl.):S11–S18.]
Fourth-Year Nursing Student Perceptions of Incidents and Incident Reporting
Authors: Espin Sherry , Meikle Diane
Published: February 2014

This study explored how fourth-year nursing students (
n
= 10) from one urban baccalaureate nursing program perceived incidents potentially harmful to patients, as well as incident reporting. Individual interviews were conducted. Five scenarios were presented in the interviews, with each scenario portraying a situation that varied in terms of the severity of potential for patient harm and the clinical team members involved. Participants’ responses were analyzed using a descriptive thematic approach. Of the 50 events (10 participants × 5 scenarios), participants identified 37 events as incidents. Three themes emerged regarding how participants identified an incident: scope of practice, professional roles, and harm to the patient. Regarding 48 of the 50 events, participants said they would report these incidents either informally or formally. Findings from this study suggest a need for nursing education regarding what constitutes an incident, as well as how and when to report incidents. [
J Nurs Educ
. 2014;53(4):238–243.]
An Educational Innovation to Foster Evidence-Informed Practice
Authors: Cable-Williams Beryl , Rush Janet , Mowry Andrea , MacLeod Ann , Gilmer Cyndi , Graham Cathy , White Sandra
Published: February 2014

This article describes an innovation in baccalaureate nursing education that is intended to assist in the preparation of nursing students for careers in which evidence-informed practice is an imperative. The innovation involves the combination of central aspects of the internationally recognized Registered Nurses’ Association of Ontario Best Practice Guidelines Program with existing curricular goals and themes in a baccalaureate nursing program at a small university in southern Ontario in Canada. [
J Nurs Educ
. 2014;53(3, Suppl.):S55–S58.]
Collaborative Learning in Nursing Simulation: Near-Peer Teaching Using Standardized Patients
Authors: Owen Amy M. , Ward-Smith Peggy
Published: February 2014

Simulation in nursing education uses specific patient scenarios to provide students with hands-on learning experiences. A near-peer teaching experience, using upper-level nursing students as standardized patients, was created as an educational intervention. The premises of social cognitive theory, which include cognitive, behavioral, and environmental factors, were incorporated into this teaching activity. The upper-level students played the role of a patient, while they also practiced leadership, teaching, and mentoring of first-semester nursing students. In the scenario, the first-semester students provided care to the patient, while focusing on safety, identifying the problem, and practicing clinical decision making. Faculty were present to provide guidance and promote communication in debriefing. Near-peer teaching provided a learning opportunity for all students, facilitated teamwork, and encouraged knowledge and skills attainment. [
J Nurs Educ
. 2014;53(3):170–173.]
Fostering Significant Learning in Graduate Nursing Education
Authors: Marrocco Geraldine F.
Published: February 2014

Faculty who want to energize graduate students with creative classes that lead to long-lasting learning will benefit by designing course objectives, learning activities, and assessment tools using Fink’s taxonomy of significant learning and Wiggins’s insights on performance-based or educative assessments. Research shows that course designs relying on content-driven lectures and written examinations do not promote significant learning among adult learners. This article reviews six types of significant learning using Fink’s taxonomy and examines Wiggins’s “backward” approach to designing courses using performance-based assessments that gauge true learning and learning that promotes a lasting change. When designing courses, educators should ask: “What do I really want students to get out of this course?” The answers will direct the design of objectives, learning activities, and assessment tools. Designing graduate courses using Fink’s taxonomy and Wiggins’s backward approach can lead to significant learning to better prepare nurse practitioners for the future of health care. [
J Nurs Educ.
2014;53(3):177–179.]
Performance of Four New Photoscreeners on Pediatric Patients With High Risk Amblyopia
Authors: Arnold Robert W. , Armitage M. Diane
Published: February 2014

Purpose:

A new study by the American Academy of Pediatrics touts the benefits of photoscreening, especially in preverbal children who cannot yet perform monocular acuity screening. Emerging devices have not been compared in young and developmentally challenged children.

Methods:

Consecutive patients in a pediatric eye practice had a comprehensive eye examination and four photoscreens: PlusoptiX (PlusoptiX, Nuremburg, Germany), SPOT (PediaVision, Lake Mary, FL), iScreen (iScreen, Memphis, TN), and the GoCheckKids application (Gobiquity, Aliso Viejo, CA) for the iPhone 4s (Apple, Cupertino, CA) with Delta Center Crescent interpretation. They were validated according to the 2003 American Association for Pediatric Ophthalmology and Strabismus uniform guidelines.

Results:

One hundred eight children aged 1 to 12 years participated, with 56% having amblyopia risk factors and 10% having autism. For the four devices, sensitivity, specificity, and inconclusive results were as follows: PlusoptiX (83%, 86%, 23%), SPOT (80%, 85%, 4%), iScreen (75%, 88%, 13%) and iScreen (with Delta Center Crescent) (92%, 88%, 0%), and GoCheckKids (with Delta Center Crescent) (81%, 91%, 3%).

Conclusions:

Even in high risk and young children, current instrument-based screeners can reliably screen for refractive and strabismic risk factors that lead to amblyopia. Some devices can reduce the proportion of inclusive results in challenging cases.

[J Pediatr Ophthalmol Strabismus 2014;51(1):46–52.]
Physician Use of White Coats in Pediatric Ophthalmology
Authors: DeBenedictis Caroline N. , Liu Grace T. , Nelson Leonard B. , Leiby Benjamin E. , Dai Yang , Levin Alex V.
Published: February 2014

Purpose:

Recent literature reports that patients and parents of pediatric patients prefer their physician to wear a white coat and to address them informally. This study aims to characterize current practice patterns of pediatric ophthalmologists regarding their use of white coats and salutations during outpatient pediatric encounters.

Methods:

An eight-question survey was e-mailed to members of the American Academy of Pediatric Ophthalmology and Strabismus in 2012. The questions focused on clinical setting, use of white coats in out-patient encounters, and preferred language used to address the patient’s parents. Surveys not completed in full were excluded from data analysis.

Results:

Of approximately 1,266 members who received the survey, 606 completed the survey. Five hundred ninety-nine surveys were included in the data analysis. Sixty-three percent of attending physicians and 80% of fellows reported they did not routinely wear white coats while examining outpatient children. Forty-six percent of attending physicians and 48% of fellows addressed the patient’s parents as “mom” or “dad”. There was no significant association between wearing a white coat and type of practice setting, practice characteristics, or location in a children’s hospital for attending physicians or fellows.

Conclusions:

Contrary to preferences expressed by patients and their parents, a majority of pediatric ophthalmologists do not routinely wear white coats during pediatric outpatient examinations. Practice patterns appear to be in line with previously reported parental greeting preferences.

[J Pediatr Ophthalmol Strabismus 2014;51(1):13–16.]
Surgical Dose-Effect Relationship in Single Muscle Advancement in the Treatment of Consecutive Strabismus
Authors: Kim Bo Hyuck , Suh Soh Youn , Kim Jeong Hun , Yu Young Suk , Kim Seong-Joon
Published: February 2014

Purpose:

To evaluate the dose-effect relationship for single muscle advancement in consecutive esotropia and consecutive exotropia.

Methods:

Medical records from 22 patients with consecutive esotropia (n = 11) or exotropia (n = 11) were retrospectively reviewed. All patients had undergone either single lateral rectus or medial rectus advancement surgery. The alterations in muscle position and the angle deviation were measured in millimeters and prism diopters (PD) and the change in deviation was determined by subtracting the postoperative angle of deviation at 1 week from the preoperative angle. To quantify the clinical effect of muscle advancement, the ratio of the change in muscle position to the change in visual angle deviation was calculated (ie, the surgical dose-effect relationship).

Results:

The mean deviation was 25.5 ± 10.4 PD preoperatively and 0 ± 6.9 PD at 1 week postoperatively. The success rate was 82% in the consecutive esotropia group and 91% in the consecutive exotropia group. The average correction ratio was 4.31 ± 0.96 PD/mm. In multiple regression analysis of total patients with consecutive strabismus and the consecutive esotropia group, the amount of muscle advancement and preoperative angle deviation were positively correlated with the correction ratio. In the consecutive exotropia group, there was no significant relationship between variables.

Conclusions:

Single muscle advancement generally provides enough correction for most consecutive strabismus cases. Surgical dose-effect relationship increases with preoperative angle deviation and amount of muscle advancement. Surgeons should consider reducing the amount of muscle advancement in patients with larger angle deviations, especially patients with consecutive esotropia.

[J Pediatr Ophthalmol Strabismus 2014;51(2):93–99.]
Treatment of Consecutive Exotropia: Unilateral Lateral Rectus Recession Combined With Medial Rectus Advancement or Resection
Authors: Mangla Deepak , Simon John W. , Mangla Neeraj , Zobal-Ratner Jitka
Published: February 2014

Purpose:

Consecutive exotropia presents a difficult clinical problem, especially when previously recessed medial recti are to be strengthened. Surgical options include advancement, typically with a small resection, and resection alone.

Methods:

The authors retrospectively reviewed records of all patients who underwent a second two-muscle surgery on a single eye for consecutive exotropia. Patients with paralytic strabismus and those with less than 1 month of postoperative follow-up were excluded. In 2003, one of the authors began medial rectus resections without advancements in most cases, whereas a second author continued to perform advancements. Two treatment groups were thus reviewed.

Results:

Forty-two patients qualified for inclusion, including 23 for the resection group and 19 for the advancement group. Preoperative deviations were similar (
P
= .35, 95% confidence interval: −2.64 to 9.82). Postoperative deviations averaged 11.4 prism diopters (PD) in the resection group and 11.5 PD in the advancement group (
P
= .98, 95% confidence interval: −12.2 to 12.3). Forty-eight percent of the resection group and 63% of the advancement group achieved alignment within 10 PD of orthophoria (
P
= .33, 95% confidence interval: −9.0% to 39%).

Conclusions:

Surgical results were favorable following both techniques. Although both techniques appear to be adequate, resection of previously recessed medial recti may be preferable because they allow use of standard surgical tables and avoid advancement of inflamed tissue into the palpebral fissure.

[J Pediatr Ophthalmol Strabismus 2014;51(2):116–119.]
ECT Treatment Outcomes Following Performance Improvement Changes
Authors: Pulia Kathy , Vaidya Punit , Jayaram Geetha , Hayat Matthew J. , Reti Irving M.
Published: February 2014

Differences in electroconvulsive therapy (ECT) outcomes were explored following changes in ECT administration at our institution. Two changes were introduced: (a) switching the anesthetic agent from propofol to methohexital, and (b) using a more aggressive ECT charge dosing regimen for right unilateral (RUL) electrode placement. Length of stay (LOS) and number of treatments administered per patient were monitored. A retrospective analysis was performed of two inpatient groups treated on our Mood Disorders Unit: those who underwent ECT in the 12 months prior to the changes (
n
= 40) and those who underwent treatment in the 12 months after the changes (
n
= 38). Compared with patients receiving ECT with RUL placement prior to the changes, patients who received RUL ECT after the changes had a significantly shorter inpatient LOS (27.4 versus 18 days,
p
= 0.028). Treatment efficacy monitored by the Montgomery Asberg Depression Rating Scale was not impacted. The change in anesthetic agent and charge dosing each accounted for 11% of the variance in LOS among patients receiving RUL ECT. The implemented changes in ECT administration positively impacted outcome for patients receiving treatment with RUL electrode placement. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(11), 20–25.]
Direct Care Staff Perspectives Related to Physical Activity in Mental Health Group Homes
Authors: Harding Shari L.
Published: February 2014

Sedentary lifestyle is a modifiable risk factor that contributes to health disparities in individuals with serious mental illness. Direct care staff in mental health group homes were surveyed to determine barriers and resource needs related to conducting physical activity interventions with individuals. An investigator-designed survey was used. The most significant barriers cited by staff were individuals did not want to engage in physical activity and staff needed more information about how to conduct physical activity interventions. Resource needs cited by staff included engagement strategies to gain and maintain individual interest as well as resource acquisition. Direct care staff are well positioned to deliver physical activity interventions but need support and direction to engage individuals in safe and effective exercise. Mental health nurses are well placed to provide support and direction to staff for these interventions. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(12), 38–43.]
A Proactive Classroom Management Model to Enhance Self-Efficacy Levels in Teachers of Adolescents Who Display Disruptive Behaviors
Authors: Pace Rolanda T. , Boykins Anita D. , Davis Sheila P.
Published: February 2014

The aims of this project were to determine teachers’ self-efficacy levels at baseline and after participating in a proactive classroom management model intervention. Teachers (
N
= 26) were recruited from a rural middle school in a south central state. Data required for analysis were drawn from the Teachers’ Sense of Efficacy Scale (long form). A statistically significant difference (
t
[25] = 7.68,
p
< 0.001) was noted in teachers’ self-efficacy levels from pre- to post-intervention. Findings support the need for proactive classroom management training for teachers as well as the need for psychiatric and mental health nurse consultants within the school system. Teacher classroom management strategies should also include appropriate response to individual student’s needs, effective communication, and insight regarding the behaviors of students from diverse backgrounds. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(2), 30–37.]
Promoting Wellness of Peer Providers Through Coaching
Authors: Brice George H. , Swarbrick Margaret A. , Gill Kenneth J.
Published: February 2014

Peer wellness coaching is workforce innovation that empowers individuals with mental and substance use disorders to achieve recovery. This article briefly describes how this approach can help peer providers develop self-care skills to improve job tenure and promote satisfaction. Promising results of this new approach are presented. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(1), 41–45.]
The Effects of Cognitive-Behavioral Therapy on Depression, Anger, and Self-Control for Korean Soldiers
Authors: Hyun Myung-Sun , Chung Hyang-In C. , De Gagne Jennie C. , Kang Hee Sun
Published: February 2014

This quasi-experimental study examined the effects of cognitive-behavioral therapy (CBT) to control depression, anger, and self-control in soldiers from South Korea. Using a pretest-posttest design, the sample was composed of an experimental group (
n
= 16) and a control group (
n
= 12). The experimental group participated in four sessions of CBT. No significant differences were found between the groups with regard to demographic characteristics. Changes in the variables after the intervention were analyzed using Wilcoxon’s signed-rank sum test. The depression scores decreased significantly after the intervention (
z
= −3.05,
p
= 0.002); whereas, the scores of state-trait anger and self-control did not change. In the control group, none of the outcome variable scores changed significantly. The results indicate that the developed CBT program might be an effective modality to decrease the depression of soldiers who are in military service. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(2), 22–28.]
Genetic Testing and Alzheimer’s Disease: Implications for Psychiatric-Mental Health Nursing
Authors: Schutte Debra L.
Published: February 2014

Alzheimer’s disease (AD), the most common cause of irreversible dementia, continues to grow in prevalence as well as public health impact. Extensive research into the genetic etiology of AD has yielded knowledge of some genetic factors that are causative and other genetic factors that increase risk for disease. Consequently, the possibility of genetic testing in individuals with or at risk for AD is a question that nurses may be asked. Psychiatric-mental health (PMH) professionals are in key positions to influence the care of individuals who are considering the effect of genetic information on their health care decisions. Whether by working within interdisciplinary genetic counseling teams to provide direct specialty services or by developing skills to identify and refer individuals at risk for or concerned about their risk for AD, PMH nurses can play an important role in the health care of individuals and families experiencing AD. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(11), 14–18.]
Concern for Truth: Driving Defensively When Confronting a Zombie Epidemic
Authors: Howland Robert H.
Published: February 2014

The newly approved drug Diclegis
®
, indicated for the treatment of nausea and vomiting associated with pregnancy, has a very interesting background story going back more than 50 years, in which science, celebrity individuals, the media, and the courts crossed paths. The story illustrates how concepts of truth, evidence, objectivity, and disinterested inquiry can become distorted in various ways, and this is especially relevant and prevalent in today’s media environment of cable television, talk radio, and especially the Internet. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(11), 9–12.]
Gabapentin for the Treatment of Substance Use Disorders
Authors: Howland Robert H.
Published: February 2014

The amino acid gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the brain. Four placebo-controlled studies found the GABA analog drug gabapentin effective for treating alcohol dependence. Gabapentin may also be effective for treating alcohol withdrawal syndromes. One placebo-controlled pilot study found gabapentin beneficial for cannabis dependence, but several controlled studies found no benefit for cocaine or methamphetamine dependence. Whether gabapentin is effective for other substance use disorders is unknown. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(12), 11–14.]
Caring for Dad at 100: Challenges and Coping Strategies
Authors: Silva Mary Cipriano
Published: February 2014

The author presents five exemplars of caregiving challenges taken from a 100-day diary she kept during her father’s 100th year and then identifies 20 coping strategies she used to decrease the stress. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(1), 17–20.]