Academic and Demographic Predictors of NCLEX-RN Pass Rates in First- and Second-Degree Accelerated BSN Programs.

Relatively few studies have addressed predictors of first-attempt outcomes (pass-fail) on the National Council Licensure Examination-Registered Nurses (NCLEX-RN) for accelerated BSN programs. The purpose of this study was to compare potential predictors of NCLEX outcomes in graduates of first-degree accelerated (FDA; n=62) and second-degree accelerated (SDA; n=173) BSN programs sharing a common nursing curriculum. In this retrospective study, bivariate analyses and multiple logistic regression assessed significance of selected demographic and academic characteristics as predictors of NCLEX-RN outcomes. FDA graduates were more likely than SDA graduates to fail the NCLEX-RN (P=.0013). FDA graduates were more likely to speak English as a second or additional language (P<.0001), have lower end-of-program GPA and HESI Exit Exam scores (both P<.0001), and have a higher proportions of grades ≤ C (P=.0023). All four variables were significant predictors of NCLEX-RN outcomes within both FDA and SDA programs. The only significant predictors in adjusted logistic regression of NCLEX-RN outcome for the pooled FDA+SDA graduate sample were proportion of grades ≤ C (a predictor of NCLEX-RN failure) and HESI Exit Exam score (a predictor of passing NCLEX-RN). Grades of C or lower on any course may indicate inadequate mastery of critical NCLEX-RN content and increased risk of NCLEX-RN failure.

Effect of virtual reality on time perception in patients receiving chemotherapy.

PURPOSE: Virtual reality (VR) during chemotherapy has resulted in an elapsed time compression effect, validating the attention diversion capabilities of VR. Using the framework of the pacemaker-accumulator cognitive model of time perception, this study explored the influence of age, gender, state anxiety, fatigue, and cancer diagnosis in predicting the difference between actual time elapsed during receipt of intravenous chemotherapy while immersed in a VR environment versus patient's retrospective estimates of time elapsed during this treatment. MATERIALS AND METHODS: This secondary analysis from three studies yielded a pooled sample of N = 137 participants with breast, lung, or colon cancer. Each study employed a crossover design requiring two matched intravenous chemotherapy treatments, with participants randomly assigned to receive VR during one treatment. Regressions modeled the effect of demographic variables, diagnosis, and Piper Fatigue Scale and State Anxiety Inventory scores on the difference between actual and estimated time elapsed during chemotherapy with VR. RESULTS: In a forward regression model, three predictors (diagnosis, gender, and anxiety) explained a significant portion of the variability for altered time perception (F=5.06, p = 0.0008). Diagnosis was the strongest predictor; individuals with breast and colon cancer perceived time passed more quickly. CONCLUSIONS: VR is a noninvasive intervention that can make chemotherapy treatments more tolerable. Women with breast cancer are more likely and lung cancer patients less likely to experience altered time perception during VR (a possible indicator of effectiveness for this distraction intervention). Understanding factors that predict responses to interventions can help clinicians tailor coping strategies to meet each patient's needs.

Application of a partnership model for transformative and sustainable international development.

There are differences of intent and impact between short-term and long-term engagement of U.S. academic institutions with communities of need in developing nations. Global health programs that produce long-term transformative change rather than transient relief are more likely to be sustainable and in ethical harmony with expressed needs of a region or community. This article explores characteristics of successful ethical partnerships in global health and the challenges that threaten them, introducing a consensus community engagement model as a framework for building relationships, evolving an understanding of needs, and collaboratively developing solutions and responses to priority health needs in underserved regions of the world. The community engagement model is applied to a case study of an initiative by a U.S. school of nursing to establish long-term relationships with the nursing community in the Caribbean region with the goal of promoting transformative change through collaborative development of programs and services addressing health care needs of the region's growing elderly population and the increasing prevalence of noncommunicable chronic diseases. Progress of this ongoing long-term relationship is analyzed in the context of the organizational, philosophical, ethical, and resource commitments embodied in this approach to initiation of transformative and sustainable improvements in public health.

Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population.

OBJECTIVE: The authors examined whether social support and locus of control (LOC), either individually or jointly, would be associated with subsequent self-reported medication adherence and treatment barriers in a sample of depressed elderly patients. METHODS: A group of 85 elderly patients with major depression was enrolled in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University and treated with a standardized algorithm. During the course of the study, participants completed measures of social support and internal locus of control (LOC). A little more than 1 year later, they completed general measures of medication adherence and treatment barriers. RESULTS: Increasing subjective and instrumental social support and non-family interaction were associated with greater adherence among patients high in internal LOC but not among patients low in internal LOC. Less instrumental social support was associated with more treatment barriers among patients low in internal LOC but not among patients high in internal LOC. CONCLUSION: The relationship between social support and antidepressant medication adherence is moderated by beliefs about control over one's illness.

A three-factor analytic model of the MADRS in geriatric depression.

OBJECTIVE: Major depression is a heterogeneous disorder, perhaps comprising several clinical subtypes or subgroups of symptoms. This study examined whether items on the Montgomery-Asberg Depression Rating Scale (MADRS) form distinct symptom subgroups among geriatric depressive patients that might form the basis of new outcome measures for tracking treatment effects. METHOD: The study examined a sample of 225 adults age 59 and older diagnosed with major depression. Factor analysis with oblique rotation was used to analyze baseline MADRS item scores. RESULTS: Three distinct interpretable factors were obtained; all ten items loaded <0.60 on a domain. The first factor, dysphoric apathy/retardation, comprised five items: apparent sadness, reported sadness, lassitude, reduced concentration, and inability to feel. Psychic anxiety, the second factor, included three items: inner tension, pessimistic thoughts, and suicidal thoughts. The third factor, vegetative symptoms, resulted from items involving sleep and appetite. CONCLUSIONS: The study produced three interpretable MADRS factors reflecting geriatric depression dimensions that may be useable to monitor focused treatment outcomes.

Allelic differences in the serotonin transporter-linked polymorphic region in geriatric depression.

Previous studies have examined the role of genetic variations in the serotonin transporter-linked polymorphic region (5HTTLPR) in affective disorders. The authors studied 182 older depressed subjects and 107 elderly control subjects and obtained DNA for genotyping at the 5HTTLPR. There were no significant differences in allele frequencies generally or for number of short alleles for the group as a whole, but interesting gender effects emerged. Among men, 23% of depressed men had two short alleles, compared with only 5% of control subjects. Among women, 67% of depressed women with more than one episode had at least one short allele, compared with 41% of single-episode female patients. Also, 74% of women with a positive family history of psychiatric illness in any female relative had at least one short allele, whereas 53% had at least one short allele who did not have such a family history. Our results add to the literature linking this gene to affective illness. The negative association of allele frequency and depression may be related to the relatively small sample size. The findings raise the possibility that this genetic locus may exert differential effects based on gender, increasing risk in men, and increasing risk of recurrence in women.