Expanding Simulation Capacity: Senior-Level Students as Teachers.

BACKGROUND: The effectiveness of using senior-level nursing students as teachers to junior-level students in simulated learning was examined in a prelicensure nursing program. Simulation requires considerable financial resources in faculty time and effort. It was theorized that using senior students as teachers for junior students in peer-assisted simulation for learning health assessment clinical skills would offer an equally effective learning experience as faculty instructors. METHOD: A total of 60 junior-level students were randomized into a simulated learning experience taught by 20 senior-level students or nursing faculty. RESULTS: Evaluation of junior students' clinical performance, postsimulation debriefing assessment, and satisfaction with the simulation learning experience indicated that senior nursing students were equally effective as faculty simulation instructors. CONCLUSION: Findings suggest that the Senior Students as Teachers program, using the train-the-trainer model, was successful in preparing students as simulation instructors and has the potential for reducing faculty time and cost, as well as enhance student peer-to-peer learning.

Clinical and laboratory characteristics of adolescents with platelet function disorders and heavy menstrual bleeding.

BACKGROUND: Platelet function disorders (PFDs) have emerged as an important etiology of heavy menstrual bleeding (HMB) in adolescents. However, neither clinical nor laboratory data have been methodically analyzed in this population subset. The objective of this study was to evaluate these parameters in order to distinguish characteristics of the disorder that in turn will lead to earlier diagnosis and therapy initiation. METHODS: Retrospective review of medical records from postmenarcheal adolescents with documented PFDs referred to a hemophilia treatment center and university faculty practices for bleeding diatheses with their clinical and laboratory data evaluated. RESULTS: Of 63 teens with documented PFDs, HMB was the most common clinical manifestation of PFD (43; 68.3%). Of these, 37 (86%) were diagnosed with PFD either at or after menarche with the diagnosis based on HMB symptoms alone. Only 6 (14%) were diagnosed with a PFD prior to menarche, based on associated bleeding, i.e., epistaxis, ecchymosis, and all developed HMB after menstruation onset. Interestingly, 20 girls were diagnosed with a PFD prior to menarche and of these, only 6 (30%) went on to develop HMB after pubertal transition, while the majority (14; 70%) did not. The average age-at-PFD diagnosis was 14.5yrs, significantly differing from the 10.9yrs average age-at-PFD diagnosis in their counterparts that, after menarche, did not develop HMB (P<.01) Blood type O occurred significantly more frequently (76%) than national norms (P <.037). Incidence of δ-Storage Pool deficiency (δ-SPD) was significantly higher (74%) than their non-HMB cohorts (45%) (P <.007). Coagulation and von Willebrand factor studies were all normal. Abnormal closure times and aggregation studies were observed in 42% and 60%, respectively, of tested girls. In 25.6% for whom standard platelet studies were normal, electron microscopy detected reduced platelet δ-granules numbers (δ-SPD). CONCLUSIONS: Adolescents with PFDs and HMB appear to be clinically distinct from their non-HMB counterparts. This group of girls is characterized by HMB the major bleeding symptom, significantly high incidences of blood group O and the δ-SPD with a PFD diagnosed well after menarche. High false negative standard platelet function study results indicate additional diagnostic strategies, particularly for δ-SPD, should be considered.