Impact of interprofessional geriatric teamwork on students' perceptions of older persons and collaborative practice.

Health professions programs lack sufficient exposure to geriatric education in curricula. The Seniors Assisting in Geriatric Education (SAGE) Program exposes interprofessional (IP) teams of health professions students to older adults. To determine the impact of an interprofessional geriatric educational experience on student perceptions of team collaboration and older adults. IP teams of three or four students (n = 662) representing eight disciplines from two institutions were paired with an older adult to promote person-centered care over three semesters. Students completed two online questionnaires (pre- and post-SAGE Program, ~10 min). 136 students completed both questionnaires. Three IP collaborative practice sub-competencies under the Roles & Responsibilities and Interprofessional Communication Core Competencies increased significantly from pre- to post-SAGE Program (p ≤ 0.002). Comparison of the means for attitudes toward geriatric patients revealed statistically significant improvement in one item, Compassion (p < .002). The SAGE Program had a positive impact on IP collaborative practice and attitudes toward older people in some, but not all, areas.

Collective Perceptions of Aging and Older Persons Held by Students From Eight Healthcare Professions.

In order to increase the number of students entering the geriatric workforce, an understanding of factors influencing career preference and what may prevent students from pursuing geriatric careers is necessary. Using a convergent parallel mixed methods approach, the aim of this study was to provide insight for geriatric educators regarding the collective perceptions of aging and older persons held by 864 students from eight healthcare professions. Quantitative questions assessed students' attitudes (Geriatric Attitudes Scale). Student responses to four open-ended questions were assessed using conventional content analysis. Results included rich narrative examples of healthcare professions students' perceptions and understanding of the aging process, as well as myths and misconceptions of aging and older persons that can be used to inform geriatric curricula across multiple health professions training and education programs. Geriatric education is a critical avenue to correct misperceptions, quell ageism and address the current shortage in the geriatrician workforce.

Comparing Professional Values of Sophomore and Senior Baccalaureate Nursing Students.

BACKGROUND: The 2015 American Nurses' Association Code of Ethics reinforces professional values in nursing, and nurse educators may need evidence of their students' professional development. METHOD: Using the Nurses Professional Values Scale-Revised (NPVS-R), researchers examined two questions: What is the relative importance of professional values (i.e., caring, trust, justice, activism, and professionalism) for beginning and graduating baccalaureate nursing students, and are there differences in professional values between these students? RESULTS: New and graduating nursing students in the current study had well-developed professional values. Sophomore-level nursing students viewed trust, caring, and justice as significantly more important than activism. Senior-level students perceived trust as significantly more important than activism and professionalism. Although total NPVS-R scores did not differ significantly between cohorts, senior-level students did score significantly higher on activism than sophomore-level students. CONCLUSION: With the revised Code, nurse educators may reevaluate the ethics curriculum. This study suggests opportunity for strengthening values beyond the nurse-client relationship, such as activism and professionalism. [J Nurs Educ. 2017;56(9):546-550.].

The effectiveness of tools used to evaluate successful critical decision making skills for applicants to healthcare graduate educational programs: a systematic review.

BACKGROUND: Students leave healthcare academic programs for a variety of reasons. When they attrite, it is disappointing for the student as well as their faculty. Advanced practice nursing and other healthcare professions require not only extensive academic preparation, but also the ability to critically evaluate patient care situations. The ability to critically evaluate a situation is not innate. Critical decision making skills are high level skills that are difficult to assess. For the purpose of this review, critical decision making and critical thinking skills refer to the same constructs and will be referred to globally as critical decision making skills. OBJECTIVE: The objective of this review was to identify the effectiveness of tools used to evaluate critical decision making skills for applicants to healthcare graduate educational programs. TYPES OF PARTICIPANTS: Adult (18 years of age or older) applicants, students enrolled and/or recent graduates (within one year from completion) of healthcare graduate educational programs. Types of interventions: This review considered studies that evaluated the utilization of unique tools as well as standard tools, such as the Graduate Record Exam or grade point average, to evaluate critical decision making skills in graduate healthcare program applicants. Types of studies: Experimental and non-experimental studies were considered for inclusion. Types of outcomes: Successful quantitative evaluations based on specific field of study standards. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. Studies published in English after 1969 were considered for inclusion in this review. Databases that included both published and unpublished (grey) literature were searched. Additionally, reference lists from all articles retrieved were examined for articles for inclusion. METHODOLOGICAL QUALITY: Selected papers were assessed by two independent reviewers using standardized critical appraisal instruments from Joanna Briggs Institute. Any disagreement between reviewers was resolved through discussion or with a third reviewer. DATA COLLECTION: Data was extracted independently by each reviewer from papers included in the review using a Microsoft Excel spreadsheet. Included data included study type, 'r' values, number of subjects and reported 'p' values. These were indexed by author, year and study title. DATA SYNTHESIS: The meta-analysis was performed using the method for effect size analysis from Hunter and Schmidt. The syntax for equations was transposed into a Microsoft Excel spreadsheet for data entry, analysis and graph creation. RESULTS: No articles or paper addressing unique tools for ascertaining critical decision making skills met the inclusion criteria. Standard tools, which were represented in the literature, assess critical decision making skills via prediction of academic and clinical success, which indicates the presence of critical decision making skills in graduate healthcare students. A total of 16 studies addressing standard tools were included in this review. All were retrospective case series studies. The date range for the included studies was 1970 to 2009. The strongest relationship was undergraduate grade point average's correlation to graduate grade point average (small effect size with an 'r' value of 0.27, credibility interval of 0.18-0.37). The second strongest relationship was between Graduate Record Examination's verbal section and graduate grade point average (small effect size with an r value of 0.24, CrI of 0.11-0.37). CONCLUSIONS: An applicant's undergraduate GPA has the strongest correlation with graduate healthcare program success of the indicators analyzed (r = 0.27, small effect size). The next best predictor of graduate healthcare program success was the GRE Verbal score (r = 0.24, small effect size). However, all of the variables carried positive correlations with graduate success, just of lesser effect size strength. This review supports the continued use of traditional indicators of graduate school potential in the undergraduate grade point average and the various sections of the Graduate Record Examination for the selection of graduate healthcare applicants. IMPLICATIONS FOR RESEARCH: Primary studies should be funded and performed to assess the use of unique tools in assessing critical thinking in graduate healthcare students.

A systematic review of the effectiveness of intravenous tranexamic acid administration in managing perioperative blood loss in patients undergoing spine surgery.

This systematic review aimed to identify the effectiveness of intravenous tranexamic acid (TXA) administration in managing perioperative blood loss in patients undergoing spine surgery. The study design was a systematic review and meta-analysis. Quantitative articles were pooled in a statistical meta-analysis using the Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument. Twelve studies totaling 934 participants carried out between 1960 and 2013 were included in the review. Intraoperative blood loss showed statistically significant (P < .0001) blood loss in the control group compared with that in the treatment group. Perioperative blood loss was approaching significance for blood loss in the control group with an overall P = .067. TXA helps reduce perioperative blood loss for patients undergoing spine surgery. TXA should be administered to patients undergoing spine surgery when significant blood loss is anticipated.

RNA polymerase II mutations conferring defects in poly(A) site cleavage and termination in Saccharomyces cerevisiae.

Transcription termination by RNA polymerase (Pol) II is an essential but poorly understood process. In eukaryotic nuclei, the 3' ends of mRNAs are generated by cleavage and polyadenylation, and the same sequence elements that specify that process are required for downstream release of the polymerase from the DNA. Although Pol II is known to bind proteins required for both events, few studies have focused on Pol II mutations as a means to uncover the mechanisms that couple polyadenylation and termination. We performed a genetic screen in the yeast Saccharomyces cerevisiae to isolate mutations in the N-terminal half of Rpb2, the second largest Pol II subunit, that conferred either a decreased or increased response to a well-characterized poly(A) site. Most of the mutant alleles encoded substitutions affecting either surface residues or conserved active site amino acids at positions important for termination by other RNA polymerases. Reverse transcription polymerase chain reaction experiments revealed that transcript cleavage at the poly(A) site was impaired in both classes of increased readthrough mutants. Transcription into downstream sequences beyond where termination normally occurs was also probed. Although most of the tested readthrough mutants showed a reduction in termination concomitant with the reduced poly(A) usage, these processes were uncoupled in at least one mutant strain. Several rpb2 alleles were found to be similar or identical to published mutants associated with defective TFIIF function. Tests of these and additional mutations known to impair Rpb2-TFIIF interactions revealed similar decreased readthrough phenotypes, suggesting that TFIIF may have a role in 3' end formation and termination.

Survivors of intimate partner violence: implications for nursing care.

As IPV increases in our society, hospitals need to prepare to best meet the needs of these individuals. Hospitals should have policies that encourage critical care nurses to consider abuse with the patients they serve. These policies need to ensure private, confidential interviewing of all patients and standardize the follow-up for any identified cases. There needs to be routine prompts in an assessment and history that clarify whether the person is in a violent situation. Nurses should understand more specifically the context of IPV and know the community resources available to survivors of this violence. Last, nurses need to recognize the physical, psychological, and emotional support they can give to these individuals. The acronym RADAR, developed by the Massachusetts Medical Society, succinctly represents the thought processes that need to occur with all domestic violence cases: R: Perform routine screening. A: Ask direct questions. D: Document findings. A: Assess patient (and children) safety. R: Review patient options and provide referrals. The ultimate aim for hospitals is to empower nurses to provide compassionate care for survivors and establish emotional climates conducive to IPV disclosure and subsequent care.

Hepatitis C: experiencing stigma.

The purpose of this study was to identify and categorize stigmas associated with hepatitis C. This article will address the qualitative analysis of participants' written narratives describing stigmatic events. These narratives were in response to a question that incorporated a functional definition of stigma. The sample consisted of 39 participants who completed a survey during support group meetings. Of the participants, 84.6% experienced hepatitis C-related stigma. With the qualitative data saturated, a total of five themes and 16 concepts were found. The idea that ignorance precedes all stigmas was refuted with the finding that some concepts may not involve ignorance, as defined in this study, about hepatitis C. This notion was further applied to existing theories concerning disease-related stigma. The findings in this study expand our current knowledge of the complexity of stigma. Implications for nursing practice will include comprehensive structural and institutional application of policy. Furthermore, population and peer education about hepatitis C and against stigma will be a worthy opponent to the problem at hand.

Hepatitis C: studying stigma.

The purpose of this study was to examine hepatitis C-related stigma within a population of liver disease support group attendees. In total, 39 participants completed a quantitative/qualitative survey during support group meetings. This article reports on the quantitative data. Data collected included the source and location of stigma and stigma's effects on health-seeking behavior and disclosure practices (DISCs). Of the participants, 84.6% experienced hepatitis C-related stigma. All who were Hispanic or older than 65 years experienced stigma. The most common source of stigma was healthcare professionals. More participants reported a decrease in DISCs than in health-seeking behavior. A small portion of participants reported increases in both. Those persons who were stigmatized by healthcare professionals were significantly more likely to subsequently decrease their health-seeking behavior. Of those who reported decreases in DISCs after being stigmatized, more than half (54.5%) were stigmatized by healthcare professionals. The most common location for stigmatization was in the home setting. The findings hold important implications for learning needs of healthcare professionals.

RNA polymerase II subunit Rpb9 is important for transcriptional fidelity in vivo.

The fidelity of yeast RNA polymerase II (Pol II) was assessed in vivo with an assay in which errors in transcription of can1-100, a nonsense allele of CAN1, result in enhanced sensitivity to the toxic arginine analog canavanine. The Pol II accessory factor TFIIS has been proposed to play a role in transcript editing by stimulating the intrinsic nuclease activity of the RNA polymerase. However, deletion of DST1, the gene encoding the yeast homolog of TFIIS, had only a small effect on transcriptional fidelity, as determined by this assay. In contrast, strains containing a deletion of RPB9, which encodes a small core subunit of Pol II, were found to engage in error-prone transcription. rpb9Delta strains also had increased steady-state levels of can1-100 mRNA, consistent with transcriptional errors that decrease the normal sensitivity of the can1-100 transcript to nonsense-mediated decay, a pathway that degrades mRNAs with premature stop codons. Sequences of cDNAs from rpb9Delta strains confirmed a significantly increased occurrence of transcriptional substitutions and insertions. These results suggest that Rpb9 plays an important role in maintaining transcriptional fidelity, whereas TFIIS may serve a different primary purpose.

What's new in acute coronary syndrome?

Patients presenting with ACS are an exciting challenge for health care providers. It has been documented that hospitals that carry out evidence-based therapies related to ACS have reduced mortality rates and better outcomes in general. The use of evidence-based practices has been shown to be more difficult in women, the elderly, and nonwhite patients. This suggests that there are opportunities to make more substantial improvements in outcomes for these groups of individuals. There is a tremendous need to use the knowledge gained in treating patients with ACS. Surprisingly little is known about why health care professionals do not institute therapies that are based on quality evidence. What could the quality outcomes such as mortality rate be for ACS persons if there were widespread use of the knowledge already in the literature regarding the care of ACS clients?