Operationalizing the Concept of Critical Thinking for Student Learning Outcome Development.

BACKGROUND: Creating a curriculum that can effectively develop critical thinking skills is an elusive outcome for undergraduate nursing programs. Despite the best efforts of faculty, employers continue to note an inability of new graduates to apply critical thinking concepts that improve patient outcomes. The lack of an operational definition of critical thinking appears to be a key contributor to this issue. METHOD: A concept analysis was developed to identify a definition of critical thinking that allows for clear, measurable learning outcomes. RESULTS: Despite extensive discussion within the literature, a consistent definition of critical thinking is lacking; instead, a rather extensive list exists of the attributes and antecedents consistently found in individuals who think critically. CONCLUSION: Curricular student learning outcomes framed around operational attributes can promote the development of critical thinking skills and improve patient outcomes. [J Nurs Educ. 2019;58(4):214-220.].

The protective effects of angiotensin II blockade with olmesartan medoxomil on resistance vessel remodeling (The VIOS study): rationale and baseline characteristics.

BACKGROUND: The VIOS (Vascular Improvement with Olmesartan medoxomil Study) study is a randomized, parallel study to determine the relative effects of suppressing the renin-angiotensin system (RAS) with the angiotensin receptor antagonist olmesartan medoxomil versus suppressing sympathetic drive with the beta-adrenoceptor antagonist atenolol on remodeling of the subcutaneous small resistance vessel. Remodeling of small resistance vessels may be the earliest pathologic finding associated with hypertension. It may predate the onset of clinically apparent hypertension. METHODS: In this study, 100 patients with stage I hypertension are characterized at baseline before being treated for 1 year to obtain a goal BP of less than 140/90 mm Hg as defined by Joint National Committee (JNC)-7. Resistance vessel remodeling is determined using the gluteal fat biopsy technique in the hypertensive patients and a group of normotensive healthy volunteers. Additionally, efforts will be made to define whether noninvasive hemodynamic parameters, retinal vessel measurement changes, or biologic markers may predict and track the underlying vascular morphologic and physiologic changes induced by either regimen during the 12-month treatment period. RESULTS: The primary endpoint will be the degree of vascular remodeling as obtained from percutaneous biopsy of gluteal subcutaneous resistance vessels in each of two treatment arms compared with the normal volunteers. The design of the study and the pertinent baseline characteristics of these patients with uncomplicated essential hypertension are presented. CONCLUSION: The suppression of the RAS by the blockade of angiotensin II type 1 (AT(1)) receptors may demonstrate remodeling effects on the ubiquitous small resistance vessels similar to that seen in the myocardium and renal glomeruli, thus affording more complete end-organ protection.