Training nursing students in motivational interviewing for alcohol misuse: A mixed method study.

BACKGROUND: Motivational interviewing led by nurses has been demonstrated to be effective in reducing alcohol consumption among university students. However, most of these professionals feel that they lack the competence necessary for motivational interviewing due to a lack of formal training in the nursing curriculum. OBJECTIVES: To design, implement and evaluate a motivational interviewing training course for alcohol misuse in an undergraduate nursing curriculum and to explore students' experiences with this course. DESIGN: A mixed-methods study involving a descriptive comparative quantitative design and qualitative focus group interviews with nursing students. SETTINGS: An elective nursing course in a Spanish university. PARTICIPANTS: A total of 21 fourth-year nursing students. METHODS: The course was developed as a twelve-week, two-hour course. It comprised three modules covering the concepts, tools and skills associated with motivational interviewing for alcohol misuse. Quantitative and qualitative data were collected after the completion of the course to evaluate the training received by students; these data were categorized using Kirkpatrick's model. The quantitative results included students' satisfaction, knowledge, skills and attitudes, which were measured using an ad hoc questionnaire, a multiple-choice exam, and two rater-based assessments (the Peer Proficiency Assessment instrument and an evidence-based checklist). Qualitative focus groups were used to explore students' experiences of the entire programme. RESULTS: Students' satisfaction with the course was rated 9 out of 10, highlighting the usefulness and adequacy of the course content. The quantitative and qualitative results both indicated that all students acquired the knowledge necessary to perform motivational interviewing and significantly improved their motivational interviewing microskills. Only half of the students reached the level of proficiency in two of the three ratios calculated. The three main themes identified pertained to the learning atmosphere, module methodologies, and students' self-perceptions of competence. Finally, the students reported having transferred their learning to clinical practice. CONCLUSION: A course on motivational interviewing for alcohol misuse positively influences nursing students both personally and in terms of their future professional work by improving their knowledge, skills, attitudes and self-perceived competence.

Cataract surgery in children with uveitis.

PURPOSE: To report the technique and postoperative results of cataract surgery in children with uveitis. METHOD: Between 1988 and 1998, nine children (age range: 2.5-11 years) who developed secondary uveitic cataract and underwent cataract extraction were studied retrospectively. Seven children had juvenile rheumatoid arthritis and two had chronic anterior uveitis of unknown etiology. The surgical technique was lensectomy and wide anterior vitrectomy with limbal approach, lysis of anterior synechiae and in some cases, peripheral iridectomy. Postoperative aphakia was corrected with soft contact lenses in all patients. Follow-up ranged from 6 months to 6 years. RESULTS: Postoperatively, visual acuity in all patients improved and final visual acuity ranged from 20/70 to 20/25. Significant intraoperative complications did not occcur in any patient. One boy with juvenile rheumatoid arthritis developed cystoid macular edema 1 month postoperatively, which was successfully managed. He also developed hypertonia 1 year later, which was also successfully managed. Seven of the nine children had fewer and milder relapses of uveitis after surgery. CONCLUSION: Cataract surgery, using the lensectomy-vitrectomy technique in children with uveitis, is a safe technique with a relatively small percentage of postoperative complications and good functional results.

Health-related quality of life after transient ischemic attack and minor stroke: is medical or surgical treatment influential?

Although randomized trials have proven the benefit of carotid endarterectomy (CEA) for appropriate patients, health care purchasers increasingly look beyond clinical outcome toward measures of cost effectiveness and health-related quality of life (HRQoL) in apportioning limited resources. We used a generic HRQoL outcome scale, the Short Form 36 (SF-36), to assess the differences in patient-perceived HRQoL in two cohorts of patients who had suffered minor cerebral ischemic events. One group (n=100) had undergone CEA, whereas members of the second cohort (n=100) were not appropriate candidates for surgery and were therefore treated with best medical therapy. The overall response rate was 83%. No significant difference in health profile between the CEA and medical cohorts was detected for the eight SF-36 domains. However, the CEA cohort rated a significantly improved change in general health over the previous year compared with the group managed medically (P<.01). A greater proportion of the former group than of the medical group thought their treatment had been successful and that their health had been improved by treatment (P<.01). Both groups shared the same anxieties over future cerebral ischemic events (P=.3). Patients' perception of HRQoL measured by the SF-36 domains was almost identical between the CEA and medical cohorts apart from a small but significant improvement in self-reported overall health in the CEA cohort. HRQoL outcome measures may be of value in future clinical trials of cerebral revascularization.