TEACHING STATISTICS ONLINE: COMPARING COMPETENCY-BASED AND TRADITIONAL LEARNING.

Background: Interdisciplinary undergraduate students are expected to develop statistical competence to interpret research findings as they advance in their healthcare studies and careers. However, students often report anxiety related to learning statistical course content.This descriptive study examined differences in statistical knowledge and self-efficacy scores of undergraduate students enrolled in online competency-based and traditional learning statistics courses.A sample of 20 nursing and interdisciplinary, undergraduate students from a Midwestern University who were enrolled in introductory statistics courses were recruited for this study. Methods: Significant differences between pre-test and post-test statistical knowledge and self-efficacy scores were compared for students receiving online competency-based learning and traditional learning statistical course content. The Current Statistics Self-Efficacy (CSSE) and the Self-Efficacy to Learn Statistics (SELS) measures determined the statistics self-efficacy scores. Results: There was a significant difference in knowledge scores from pre- to post-test in the areas of hypothesis testing (p =.02), measures of central tendency (p =.001), and research design (p =.001), but there was not a significant difference in overall mean scores between competency-based learning and the traditional learning groups (p =.10). The pre-test to post-test Current Statistics Self-Efficacy student scores improved significantly in both the competency-based learning (p <.001) and traditional learning (p <.001) statistics course sections; and the Self Efficacy to Learn Statistics pre-test to post-test scores were also significantly improved in the competency-based (p <.001) and traditional (p =.02) learning groups. Conclusions: Both online competency-based and traditional learning methods improved interdisciplinary undergraduate students' statistical knowledge and self-efficacy scores. Online competency-based learning was described by the students as at least as beneficial as traditional learning for studying statistics while allowing more flexibility to repeat content until it was mastered. Purpose: This study compared pre- and post-test differences in statistical knowledge and self-efficacy scores of students enrolled in online competency-based learning and traditional learning statistics class sections.

Effects of Sleep on Adolescents' Appetite, Dietary Intake, and Weight.

Introduction: Several factors have been associated with excess weight gain in adolescents, including loss of sleep. Objective: The purpose of this study is to examine the effects of sleep factors on appetite, dietary intake, and the body weights of adolescent youth. Methods: A prospective correlational study design was used. Male and female adolescents (N = 76) ages 12-18 years completed a 5-night study. Sleep was assessed using Fitbits (88.5% accuracy) and the Pittsburgh Sleep Quality Index (PSQI) (test-retest reliability = .81); appetite was assessed by a Visual Analog Scale (α = 0.84); dietary intake was assessed by the Block Kids Food Screener (reliability up to .88); sleep hygiene was assessed using the Adolescent Sleep Hygiene Practice Scale (α = .67). Results: Poor sleep quality was reported by 39.5% of participants, and 75% of participants had inadequate sleep time (7.33 h). Participants' age significantly correlated with PSQI scores (r = .28, p < .05) and BMI (r = .37, p < .01). Participants' PSQI scores significantly correlated with sleep hygiene (r = .45, p = .05) and appetite (r = .3 3, p < .01). Sleep latency significantly correlated with sleep hygiene (r = .32, p < .05). Several sleep hygiene factors correlated significantly with the participants' sleep quality, quantity and latency scores and dietary intakes. Conclusion: These findings suggest that changes in sleep hygiene practices may improve adolescent sleep quality and quantity as well as appetite and dietary intake.

Preoperative Nutritional Status and Risk for Subsyndromal Delirium in Older Adults Following Joint Replacement Surgery.

BACKGROUND: Subsyndromal delirium following surgery in older adults is related to increased lengths of hospital stay and increased admissions to long-term care. Impaired nutrition increases risk for delirium, but its relationship to subsyndromal delirium remains unclear. PURPOSE: This correlational study examined the relationship between nutritional status and subsyndromal delirium in older adults. METHODS: Assessments for subsyndromal delirium in 53 adults 65 years or older were completed for three consecutive days following joint replacement surgery. Relationships between nutritional status and subsyndromal delirium were analyzed. Level of significance for all tests was set at p ≤ .05. RESULTS: Participants' scores from the Mini Nutritional Assessment screen were significantly related (p = .05) to subsyndromal delirium severity after accounting for variability posed by age and cognition status. CONCLUSION: When preoperative risk assessment of older adults indicates nutritional risk, preoperative optimization may improve effectiveness of delirium prevention efforts.

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery.

This study examined the effects of pain and opioid intakes on subsyndromal delirium in older adults who had joint replacement surgery. Delirium assessments of 53 older adults were completed on the first, second, and third days following joint replacement surgery using the Confusion Assessment Method (CAM). Statistical relationships were analyzed using correlations and multiple regressions. Subsyndromal delirium developed in 68% (n = 36) of participants. Pain was significantly related (p < .05) to increased delirium symptoms after accounting for preoperative risk factors of comorbidity, cognitive status, fall history, and preoperative fasting times, whereas opioid intake was not significantly associated with increased delirium symptoms. Findings suggest older adults with increased pain levels are at higher risk for subsyndromal delirium as well as delirium after joint replacement surgery.

Unique Stroke Symptoms in Women: A Review.

BACKGROUND: Research suggests that there is a delay in recognizing unique stroke symptoms in women by both healthcare professionals and the general population. The purpose of this review was to identify and summarize the most relevant literature regarding recognition and assessment of unique stroke symptoms in women. METHODS: Literature review using PubMed, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar was used to search literature describing unique stroke symptoms. RESULTS: Unique stroke symptoms, female sex, and race are associated with delayed recognition, treatment, misdiagnosis, and outcomes. Women experience unique symptoms of nausea/vomiting, headache, dizziness, and cognitive dysfunction more often than men. Stroke assessment tools and registries recognize 1 to 4 of the 11 unique stroke symptoms in women, no study directly assesses the sensitivity and specificity of these unique symptoms, and all studies included women and men. Conclusions and Nursing Implications: Current assessment tools and registries are not sensitive and specific to measuring unique stroke symptoms in women. Accurately identifying unique stroke symptoms in women may reduce presentation and treatment time, minimizing misdiagnoses and poor patient outcomes.

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery.

BACKGROUND: Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. PURPOSE: This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. METHODS: Delirium assessments of a sample of 62 adults 65 years of age or older were completed on postoperative Days 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. RESULTS: Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). CONCLUSIONS: Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

The Relationship Between Religiosity and Health-Promoting Behaviors in Pregnant Women.

Pender's health promotion model guided this descriptive/correlational study exploring the relationship between religiosity and health-promoting behaviors of pregnant women at Pregnancy Resource Centers (PRCs). A consecutive sample included women who knew they were pregnant at least 2 months, could read/write English, and visited PRCs in eastern Pennsylvania. Participants completed self-report surveys that examined religiosity, demographics, pregnancy-related variables, services received at PRCs, and health-promoting behaviors. Women reported they "sometimes" or "often" engaged in health-promoting behaviors, Hispanic women reported fewer health-promoting behaviors than non-Hispanic women, and women who attended classes at the centers reported more frequent health-promoting behaviors than those who did not attend classes. In separate multiple linear regressions, organized, non-organized, and intrinsic religiosity and satisfaction with surrender to God explained additional variance in health-promoting behaviors above and beyond what Hispanic ethnicity and attending classes at the PRCs explained in pregnant women at PRCs.

Neurobehavioral Effects of Consuming Dietary Fatty Acids.

BACKGROUND: Research results on the neurobehavioral effects of consuming dietary fatty acids are mixed. Therefore, this study examined the effects of consuming dietary fatty acids on depression, mood, and anxiety. METHODS: In this randomized crossover-design study, 37 university students served as their own controls, consuming each of the following diets for a 4-day period with a 2-week washout period between diets: (1) low fatty acid, (2) high saturated fatty acid (SFA), (3) high polyunsaturated fatty acid (PUFA), and (4) control. The order of sessions was counterbalanced across dietary groups. Following consumption of each diet, participants were examined for within-subject differences in depression, mood, and anxiety. Measures included weighed dietary fat intakes, Zung's Self-Rating Anxiety and Depression Scales, and the Positive and Negative Affect Schedule. RESULTS: Participants had significantly higher positive affect scores (p < .007) and were significantly less irritable (p < .04) when they consumed diets rich in SFAs and PUFAs than when they consumed a low fatty acid or control diet. However, depression, anxiety, and negative affect scores did not differ significantly among diets. Analysis of participants' serum lipid levels following their intake of the fatty acid and control diets indicated significantly higher levels of total cholesterol (p = .006) and serum triglycerides (p = .003) with the control diet. CONCLUSIONS: These results highlight the neurobehavioral benefits of consuming dietary fatty acids among healthy individuals. By concentrating on the positive effects of diet on affective processes, health professionals can also provide support for at-risk individuals.

Risk Factors for Cholelithiasis.

Gallstone disease is one of the most common public health problems in the United States. Approximately 10%-20% of the national adult populations currently carry gallstones, and gallstone prevalence is rising. In addition, nearly 750,000 cholecystectomies are performed annually in the United States; direct and indirect costs of gallbladder surgery are estimated to be $6.5 billion. Cholelithiasis is also strongly associated with gallbladder, pancreatic, and colorectal cancer occurrence. Moreover, the National Institutes of Health estimates that almost 3,000 deaths (0.12% of all deaths) per year are attributed to complications of cholelithiasis and gallbladder disease. Although extensive research has tried to identify risk factors for cholelithiasis, several studies indicate that definitive findings still remain elusive. In this review, predisposing factors for cholelithiasis are identified, the pathophysiology of gallstone disease is described, and nonsurgical preventive options are discussed. Understanding the risk factors for cholelithiasis may not only be useful in assisting nurses to provide resources and education for patients who are diagnosed with gallstones, but also in developing novel preventive measures for the disease.

Dietary Macronutrients and Sleep.

This study examined the effects of macronutrient diets on sleep quantity and quality. Using a repeated-measures, randomized crossover study design, 36 young adults served as their own control, and consumed high protein, carbohydrate, fat, and control diets. Treatment orders were counterbalanced across the dietary groups. Following consumption of the study diets, sleep measures were examined for within-subject differences. Fatty acid intakes and serum lipids were further analyzed for differences. Sleep actigraphs indicated wake times and wake minutes (after sleep onset) were significantly different when comparing consumption of macronutrient diets and a control diet. Post hoc testing indicated high carbohydrate intakes were associated with significantly shorter (p < .001) wake times. Also, the Global Pittsburgh Sleep Quality Index© post hoc results indicated high fat intake was associated with significantly better (p < .05) sleep in comparison with the other diets. These results highlight the effects that dietary manipulations may have on sleep.

The effects of dietary tryptophan on affective disorders.

Using a randomized crossover study design, 25 healthy young adults were examined for differences in anxiety, depression, and mood after consuming a high tryptophan and a low tryptophan diet for 4days each. There was a 2week washout between the diets. A within-subjects analysis of the participants' mood indicated significantly (p<.01) more positive affect scores after consuming a high tryptophan diet as compared to a low tryptophan diet. Negative affect differences between the diets were not statistically significant (p>.05). Also, consuming more dietary tryptophan resulted in (p<.05) less depressive symptoms and decreased anxiety.

Patients' experiences with cholecystitis and a cholecystectomy.

Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

Neurobehavioral effects of aspartame consumption.

Despite its widespread use, the artificial sweetener aspartame remains one of the most controversial food additives, due to mixed evidence on its neurobehavioral effects. Healthy adults who consumed a study-prepared high-aspartame diet (25 mg/kg body weight/day) for 8 days and a low-aspartame diet (10 mg/kg body weight/day) for 8 days, with a 2-week washout between the diets, were examined for within-subject differences in cognition, depression, mood, and headache. Measures included weight of foods consumed containing aspartame, mood and depression scales, and cognitive tests for working memory and spatial orientation. When consuming high-aspartame diets, participants had more irritable mood, exhibited more depression, and performed worse on spatial orientation tests. Aspartame consumption did not influence working memory. Given that the higher intake level tested here was well below the maximum acceptable daily intake level of 40-50 mg/kg body weight/day, careful consideration is warranted when consuming food products that may affect neurobehavioral health.

Effects of hydration on cognitive function of pilots.

The objective of this study was to examine the effect of fluid intake and possible dehydration on cognitive flight performance of pilots. A repeated-measures, counterbalanced, mixed study design was used to examine differences in working memory, spatial orientation, and cognitive flight performance of 40 randomly selected healthy pilots after having high and low fluid intakes. Serial weights were also analyzed to determine differences in cognitive flight performance of the dehydrated (1-3% weight loss) and hydrated study participants. Results showed flight performance and spatial cognition test scores were significantly (p < 0.05) poorer for pilots who had low fluid intakes and experienced dehydration in comparison to the hydrated pilots. These findings indicate fluid intake differences resulting in dehydration may have safety implications because peak cognitive performance among pilots is critical for flight safety.

Nutritional effects on sleep.

The purpose of this study was to examine the nutritional effects on sleep using actigraphy measures. A repeated-measures, counterbalanced, crossover study design was used to administer treatment diets to 44 adult participants. Participants served as their own control and consumed high-protein, high-fat, high-carbohydrate, and control diets. The study participants wore Motionlogger Actigraph sleep watches while consuming weighed food intakes for 4 days over four different treatment periods. Demographic and laboratory data were also analyzed. Actigraph results showed that the wake episodes and sleep latencies were significantly different when comparing the macronutrient intakes of the participants. Post hoc test results showed that high-protein diets were associated with significantly fewer (p = .03) wake episodes and high-carbohydrate diets were associated with significantly shorter (p < .01) sleep latencies than control diets. Thus, consumption of specific macronutrient intakes may have a significant influence on sleep.

Dietary Effects on Cognition and Pilots' Flight Performance.

The purpose of this study was to investigate the effects of diet on cognition and flight performance of 45 pilots. Based on a theory of self-care, this clinical study used a repeated-measure, counterbalanced crossover design. Pilots were randomly rotated through 4-day high-carbohydrate, high-protein, high-fat, and control diets. Cognitive flight performance was evaluated using a GAT-2 full-motion flight simulator. The Sternberg short-term memory test and Vandenberg's mental rotation test were used to validate cognitive flight test results. Pilots consuming a high-protein diet had significantly poorer (p < .05) overall flight performance scores than pilots consuming high-fat and high-carbohydrate diets.

Measuring physical activity during pregnancy.

Few studies exist that identify a useful self-report measure of physical activity for pregnant women. The purpose of this study was to compare the self-report exercise diary with the pedometer and determine if self-report measurement provided useful physical activity measures during pregnancy. The pregnant women's sleep, parity, and related demographic factors were further analyzed for relationships to the physical activity measures. Physical activity was assessed in a sample of 94 pregnant midwestern U.S. women ages 18 to 38 years. The women wore a pedometer during all waking hours for 3 consecutive days at 14 and 28 weeks of pregnancy for a total of 6 days. During the same 6 days of monitoring, the women kept a diary account of the minutes they exercised per day. The pedometer and self-report exercise diary results correlated significantly (r = 49, p = .02). When examining for usefulness in measuring physical activity, a comparison of the women's occupational categories revealed no significant differences in self-reported minutes of exercise or pedometer counts per day.