A Short Form for Measuring Anxiety in Nursing Education.

Background and Purpose: Nursing education lacks an easily accessible, valid, and reliable short instrument to support researchers and instructors in quickly assessing student anxiety. The purpose of this research was to respond to this need by assessing the reliability and validity of a short-form anxiety instrument adapted from psychology which could measure state and trait anxiety. Methods: Using a one-group, repeated measures design, 51 sophomore level undergraduate nursing students had their state and trait anxiety levels measured at three time points over the course of a semester. Results: Results showed that the anxiety instrument was valid and reliable for use in nursing education with coefficient α ranging from .65 to .88. Conclusion: Future nurse researchers and educators should consider using the short-form anxiety instrument when a quick differentiation is needed to measure state and trait anxiety.

An AI-based framework for studying visual diversity of urban neighborhoods and its relationship with socio-demographic variables.

This study presents a framework to study quantitatively geographical visual diversities of urban neighborhood from a large collection of street-view images using an Artificial Intelligence (AI)-based image segmentation technique. A variety of diversity indices are computed from the extracted visual semantics. They are utilized to discover the relationships between urban visual appearance and socio-demographic variables. This study also validates the reliability of the method with human evaluators. The methodology and results obtained from this study can potentially be used to study urban features, locate houses, establish services, and better operate municipalities.

A rasch analysis of three socialization and communication measures in 4th-year doctor of pharmacy students.

The impact of communication and anxiety on Doctor of Pharmacy students across three measures was examined. Data were collected (N = 120) from 4th-year Doctor of Pharmacy students at a historically black college/university using the Interprofessional Socialization and Valuing Scale, the Personal Report of Communication Apprehension, and the Social Phobia Inventory. Results of Rasch Differential Item Functioning Analysis indicated statistically significant differences between each ethnic group on subcomponents of anxiety in each measure (20% Caucasian, 43% African American, 31.7% Asian, and 4.2% others). Evidence from this study shows that racial demographics affect different subscales of anxiety across doctoral pharmacy students. While some pedagogical implications exist, issues within the measures and their items must also be addressed.

Impact and feasibility of a pharmacist-delivered pharmacotherapy rotation on pediatric resident education.

Pharmacotherapy training for pediatric residents is an important part of their overall education. Limited data exist describing formal engagement of clinical pharmacists in residency training. The objective of this study was to evaluate a novel pharmacotherapy rotation for learner gains and program feasibility. We designed a novel pharmacotherapy rotation (PTR) involving a pharmacist preceptor, pediatric resident, and final-year pharmacy students in the pediatric intensive care unit (PICU). Rotation objectives and content were based on learning gaps identified in a review of the resident curriculum. Data from PTRs completed 2014-2020 were used to evaluate PTR impact on residents' knowledge and confidence in pharmacotherapy decision-making, and interprofessional valuing. We also addressed PTR feasibility for long-term and for adoption by others. Measures for demographic, knowledge, and confidence measures were administered to intervention and control groups. Measures for interprofessional valuing and post-PTR feedback were administered only to the intervention group. Pre-post gains were greater for intervention residents (n = 7) than for control (n = 10), (knowledge: p = 0.02, confidence: p < 0.0001). Interprofessional valuing gain for the intervention group was significant (p = 0.004). Few PTR changes have been necessary since initial implementation. Residents provided high ratings of PTR experiences and specific value-added benefits. Designing an inter-professional PTR within the existing PICU and pharmacy rotation enhanced feasibility, curriculum consistency, and flexibility to optimize inter-professional learning.Participation in the PTR enhanced resident pharmacotherapy knowledge and decision-making, and engagement in interprofessional practice. Next steps include expanding the PTR to other settings and specialties with further evaluation study.

Evaluation of social phobia, comfort in communication, and interprofessional value during advanced pharmacy practice experiences: A focus on pharmacy student and medical resident interprofessional education.

BACKGROUND: We implemented and evaluated communication and interprofessional socialization after a unique rotation between final year pharmacy students and medical residents. INTERPROFESSIONAL EDUCATIONAL ACTIVITY: Pharmacy students on an advanced pharmacy practice experience (APPE) in pediatric critical care completed a standard experience with (i.e. intervention group) or without (i.e. control group) a medical resident as part of the pharmacy team. The objectives of this study were to evaluate pharmacy student social phobia, communication apprehension, interprofessional socialization, value placed on interprofessional teams, and comfort interacting with a physician as a result of the APPE. Practicality and sustainability were also evaluated. DISCUSSION: Forty-six students participated (28 control, 18 intervention). Both groups had similar baseline characteristics and measure scores. No changes were observed in social phobia or communication apprehension. Both control and intervention groups showed improved scores in interprofessional socialization and valuing. Scores on the Self-Perceived Ability subscale of the Interprofessional Socialization and Valuing Scale increased for the intervention group, but not for the control group. Comfort interacting with a physician was higher in the intervention than the control group. Minimal changes to the APPE were made during the six-year study, and practicality and sustainability were positive. IMPLICATIONS: Limited data describe interactions between pharmacy students and medical residents on APPEs. Participating students increased their comfort and self-perceived ability in interacting with a physician. Due to the limited need for extra time or financial resources, this experience could be applied and studied in additional settings to assist in preparing practice ready pharmacists.

Serum-derived bovine immunoglobulin for children with diarrhea-predominant irritable bowel syndrome.

BACKGROUND: Oral serum-derived bovine immunoglobulin (SBI)/protein isolate is a medical food intended to manage chronic diarrhea. It has been shown to improve pain and diarrhea in adults with diarrhea-predominant irritable bowel syndrome (d-IBS). AIM: To determine if SBI can improve symptoms in children with d-IBS. METHODS: We performed a randomized, double-blind, placebo-controlled, pilot study (NCT02609529) to evaluate the effectiveness of SBI in children 8-18 years with d-IBS. We recorded stool number, abdominal pain, and stool form in all patients for 1 week and then assigned the patients at a ratio of 2:1 to treatment with SBI 5 g BID or placebo for 3 weeks. The patients and their parents completed the Pediatric Quality of Life Inventory™ for Gastrointestinal Symptoms (PedsQOL) and the Pediatric Functional Disability Index (FDI). In addition, complete blood counts and serum chemistries were recorded at the start and end of treatment to evaluate safety. RESULTS: Fifteen patients (nine SBI, six placebo) completed the study. Both SBI and placebo groups reported nonstatistical reductions in stool frequency per week. The SBI group showed a significant reduction in stool frequency at weeks 1 and 2 but not at the end of treatment. The SBI group also demonstrated statistical improvements in abdominal pain and stool form by 3 weeks. The placebo group did not achieve similar improvements. The overall FDI and PedsQOL scores, as well as PedsQOL subscale scores for pain, discomfort when eating, diarrhea, worry about stomach aches, and communication, improved significantly in the SBI group, but not in the placebo group. No serious adverse events occurred. Serum chemistries and hemograms were normal at baseline and at the end of study in all patients. CONCLUSION: In this single-center, exploratory pilot study, we demonstrated that 10 g SBI per day was safe in children with d-IBS and improved symptoms. Larger studies, with longer treatment duration, seem warranted based on these initial positive results.

Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors.

Pulmonary hypertension is a potentially fatal disease. Despite pharmacological advances in pulmonary hypertension, fatigue remains common in patients with pulmonary hypertension. A convenience sample of 120 participants at an international patient conference completed the Multidimensional Fatigue Inventory (MFI)-20 scale. Data on New York Heart Association Functional Class, body mass index, oxygen use and medication type/use were also collected. There was a high prevalence of "severe" to "very severe" fatigue for each dimension: General Fatigue (60%), Physical Fatigue (55.8%), Reduced Activity (41.7%), Reduced Motivation (32.5%) and Mental Fatigue (27.5%). The mean±sd overall MFI-20 score was 58±5.1. Dimensions with the highest averaged levels were General Fatigue (13.40±3.61), Physical Fatigue (13.23±3.67) and Reduced Activity (11.33±4.16). Body mass index correlated with higher fatigue scores. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination negatively predicted General Fatigue, Physical Fatigue, Reduced Motivation and Reduced Activity. Triple therapy was a significant predictor of General Fatigue, Physical Fatigue and Reduced Activity. There were no significant predictors of Mental Fatigue. Multidimensional fatigue is common and severe in patients with pulmonary hypertension. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination resulted in lower scores in most fatigue dimensions. Comprehensive assessment of fatigue should be considered in the clinical care of patients with pulmonary hypertension and clinical research to develop formal interventions that target this disabling symptom.

The Relationship Between Socioeconomic Status (SES) and NCLEX-RN: Comparing SES Indicators in Mediated Logistic Regression.

The main purpose of this study was to examine the relationship between socioeconomic status (SES), ACT test scores, and the National Council Licensure Examination-Registered Nurse (NCLEX-RN) through a mediated logistic regression model. ACT is often considered one of the strongest predictors of success on the NCLEX-RN. Data from nursing students (N = 1,176) at a large, Midwestern university were analyzed. The goal was to determine if the predictive power of ACT on the NCLEX-RN stems from the influence of SES on ACT. A significant indirect effect through the causal chain of Pell Grant eligibility (i.e., SES)→ACT→NCLEX-RN was found.

The histopathologic reliability of tissue taken from cadavers within the gross anatomy laboratory.

The purpose of this study was to examine the histopathologic reliability of embalmed cadaveric tissue taken from the gross anatomy laboratory. Tissue samples from hearts, livers, lungs, and kidneys were collected after the medical students' dissection course was completed. All of the cadavers were embalmed in a formalin-based fixative solution. The tissue was processed, embedded in paraffin, sectioned at six micrometers, and stained with H&E. The microscope slides were evaluated by a board certified pathologist to determine whether the cellular components of the tissues were preserved at a high enough quality to allow for histopathologic diagnosis. There was a statistically significant relationship between ratings and organ groups. Across all organs, there was a smaller proportion of "poor" ratings. The lung group had the highest percentage of "poor" ratings (23.1%). The heart group had the least "poor" ratings (0.0%). The largest percentage of "satisfactory" ratings were in the lung group (52.8%), and the heart group contained the highest percentage of "good" ratings (58.5%) The lung group had the lowest percentage of "good" ratings (24.2%). These results indicate that heart tissue is more reliable than lung, kidney, or liver tissue when utilizing tissue from the gross anatomy laboratory for research and/or educational purposes. This information advises educators and researchers about the quality and histopathologic reliability of tissue samples obtained from the gross anatomy laboratory. Anat Sci Educ 11: 207-214. © 2017 American Association of Anatomists.

Resident Workshop Standardizes Patient Handoff and Improves Quality, Confidence, and Knowledge.

OBJECTIVES: Residency programs are required to instruct residents in handoff; however, a handoff curriculum endorsed by the Accreditation Council for Graduate Medical Education does not exist. Although curricula are available, we preferred to use a curriculum that could be taught quickly, was easy to implement, and used a mnemonic that resembled current practices at our institution. We designed and implemented a novel handoff educational workshop intended to improve resident confidence and performance. METHODS: In this observational study, pediatric residents across postgraduate training years during winter 2014-spring 2015 participated in two study segments: a handoff workshop with questionnaires and handoff observations. Co-investigators developed and led an interactive workshop for residents that emphasized a standardized approach using the SIGNOUT mnemonic (see text for definition). The effect of workshop participation on handoff abilities was evaluated using a validated, handoff evaluation tool administered before and after the workshop. Qualitative feedback was obtained from residents using pre- and postworkshop surveys. RESULTS: Forty-three residents participated in the workshop; 41 residents completed handoff observations. Improvements were noted in clinical judgment (P = 0.02) and organization/communication (P = 0.005). Pre- and postworkshop surveys demonstrated self-perceived increases in confidence, comfort, and knowledge (P < 0.001). CONCLUSIONS: Improvements in handoffs, particularly in clinical judgment and organization/communication domains, suggest that a more standardized handoff approach is beneficial, especially for postgraduate year 1 residents. The novel, interactive workshop we developed can be taught quickly, is easy to implement, is appropriate for all resident training levels, and improves resident confidence and skill. This workshop can be implemented by training programs across all disciplines, possibly leading to improved patient safety.

How the Integration of Pathology in the Gross Anatomy Laboratory Affects Medical Students.

PROBLEM: The main objective of this project was to integrate pathologists into the gross anatomy laboratory setting to increase the exposure that early medical students receive to pathologists as clinicians. INTERVENTION: Pathologists visited the gross anatomy laboratory 3 times throughout the 15-week course to assist medical students in determining the cause of death of the cadaver being dissected. CONTEXT: This intervention was implemented with 1st-semester medical students for 2 consecutive years (a total of 100 dissection teams consisting of 4 students in each team). OUTCOME: A quantitative content analysis was performed on the students' end of the course assignments to determine whether the students learned a greater percentage of pathologic information by having interactions with pathologists in the gross lab and to identify trends in the way medical students diagnosed their "first patient" (i.e., the cadaver). The students who had interactions with pathologists in the laboratory had significantly more pathology in their narrative than the students who did not receive pathologist interaction. They were also more likely to conclude that the cadaver they dissected actually died from a cause other than the one listed on the death certificate (18.3%; n = 15) compared to the students who had no pathologist interaction (1.8%; n = 2). A postintervention survey indicated that 65% of students felt that interaction with pathologists helped them understand the clinical application of gross anatomy, more than 40% become more interested in pathology, and 74% would have liked to have had more pathologist interaction. LESSONS LEARNED: This intervention demonstrated a way to increase pathologist interaction within the undergraduate medical curriculum and enhance the educational environment of the gross anatomy laboratory.

The integration of brain dissection within the medical neuroscience laboratory enhances learning.

The purpose of this study was to design a one-hour brain dissection protocol for a medical neuroscience course and evaluate the short and long-term effects of its implementation on medical students. First-year medical students (n = 166) participated in a brain dissection activity that included dissection of the basal nuclei and associated deep brain structures. Short-term retention was assessed by administering identical pre- and post-activity tests involving identification of brain structures. Following the brain dissection, the students' posttest scores were significantly higher (68.8% ± 17.8%; mean percent score ± SD) than their pretest scores (35.8% ± 20.0%) (P ≤ 0.0001). Long-term retention was evaluated by conducting an identical assessment five months after completion of the course. Students who participated in the dissection activity (n = 80) had significantly higher scores (46.6% ± 23.8%) than the students who did not participate in the dissection activity (n = 85) (38.1% ± 23.9%) (P ≤ 0.05). In addition to the long-term retention assessment, the NBME® Subject Examination scores of students who participated in the dissection activity were significantly higher than the students who did not participate in the dissection activity (P ≤ 0.01). Results suggest that this succinct brain dissection activity may be a practical addition to an undergraduate medical neuroscience course for increasing the effectiveness of neuroanatomy training. This effect may have long-term benefits on knowledge retention and may be correlated with higher performance levels on standardized subject examinations. Anat Sci Educ 9: 565-574. © 2016 American Association of Anatomists.

Racial Differences in Communication Apprehension and Interprofessional Socialization in Fourth-Year Doctor of Pharmacy Students.

OBJECTIVE: To examine racial differences in communication apprehension and interprofessional socialization in fourth-year PharmD students and to investigate the relationship between the two constructs. METHODS: Two measures with reliability and validity psychometric evidence were administered to fourth-year pharmacy students at a single historically black university with a large racial minority population. The Personal Report of Communication Apprehension (PRCA-24) measures level of fear or anxiety associated with communication. The Interprofessional Socialization and Valuing Scale (ISVS) measures beliefs, attitudes, and behaviors towards interprofessional collaborative practice. RESULTS: One hundred fourteen students completed the survey. This produced a 77.4% response rate and 45.6% of the participants were African American. There were significant differences between races (ie, White, African-American, and Asian) on both measures. The PCRA-24 and ISVS were significantly correlated in each racial group. CONCLUSION: As pharmacy education moves to more interprofessional collaborations, the racial differences need to be considered and further explored. Pharmacy curricula can be structured to promote students' comfort when communicating interprofessionally across racial groups. Understanding of culture and early education in cultural competence may need to be emphasized to navigate racial or cultural differences.

Functional Gastrointestinal Disorders Dominate Pediatric Gastroenterology Outpatient Practice.

OBJECTIVES: Symptom-based diagnostic criteria have improved recognition and standardization of pediatric functional gastrointestinal disorders (FGIDs). We used Rome 3 diagnostic criteria to determine the prevalence of FGIDs in pediatric gastroenterology clinic. In the process, we developed a diagnostic questionnaire for infants and toddlers. METHODS: We enrolled new patients ≤18 years referred during 19 months to a pediatric gastroenterology clinic. Subjects or parents completed a demographic survey and a the Questionnaire on Pediatric Gastrointestinal symptoms, Rome 3 Version (if ≥4 years, or a new infant-toddler questionnaire) before their appointment. RESULTS: We acquired data from 976 subjects: 476 boys, 592 white. Of 332 subjects <4 years, 172 (52%) met diagnostic criteria for ≥1 FGIDs. Of 644 subjects ≥4 years, 486 (75%) met diagnostic criteria for ≥1 FGIDs. Thirty one (9%) subjects <4 years and 170 (26%) subjects ≥4 years met the criteria for ≥2 FGIDs. Of the total sample of subjects <4 years, common FGIDs included functional constipation (29%), infant regurgitation (13%), and cyclic vomiting syndrome (10%). Of the total sample of subjects ≥4 years, common FGIDs included irritable bowel syndrome (36%), abdominal migraine (19%), functional constipation (17%), cyclic vomiting syndrome (8%), functional abdominal pain syndrome (7%), aerophagia (7%), and functional dyspepsia (7%). CONCLUSIONS: More than half of new pediatric gastrointestinal clinic patients met the Rome 3 criteria for ≥1 FGIDs. Satisfying the criteria may facilitate diagnosis on the first visit.

Disability in Children and Adolescents With Irritable Bowel Syndrome and/or Fibromyalgia.

To compare disability and emotional health in individuals with irritable bowel syndrome (IBS), fibromyalgia, or both, patients completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III, childhood Functional Disability Inventory (FDI), and the Behavior Assessment System for Children, Second Edition. Patients' (age range 8-18 years, 19 IBS, 12 fibromyalgia, and 12 both) FDI scores showed greater disability than scores from historically healthy patients. Fibromyalgia (FDI 22.5 ±â€Š12.7, P = 0.018) and patients with both (FDI 26.2 ±â€Š13.8, P = 0.001) averaged greater disability than those with IBS (FDI 10.6 ±â€Š7.9). Disability was correlated with anxiety and depression symptoms. Disability and psychological symptoms are important when evaluating individuals with fibromyalgia and IBS.

Examining the factor structure of the Pain Catastrophizing Scale (PCS) as a measure of victim response to the psychological pain of subtle workplace bullying.

BACKGROUND AND PURPOSE: Literature addressing victim-bully dynamics suggests that subtle bullying is prevalent in health care, both in practice and educational settings. The complex dynamics of workplace bullying complicate its assessment. The purpose was to investigate the factor structure of the Pain Catastrophizing Scale (PCS) for modeling victim responses to subtle workplace bullying. METHODS: Nursing faculty members from multiple Midwestern universities (N = 116) completed the PCS online. RESULTS: The 3-factor PCS structure (i.e., Rumination, Helplessness, Magnification) developed to describe victim response to chronic physical pain was useful in describing victim response to the chronic psychological pain of bullying via confirmatory factor analysis (CFA). CONCLUSIONS: With minor modifications, the PCS represented the construct of victim response to bullying's psychological pain.

A conceptual overview of Structural Equation Modeling (SEM) in rehabilitation research.

Structural Equation Modeling (SEM) is a collection of statistical techniques used to determine the degree to which a proposed theoretical model is supported by data. SEM has been growing in various disciplines as well as in rehabilitation research. It is the goal of this introduction to provide a conceptual overview of SEM. This statistical technique can facilitate a better understanding of large data sets involving theoretical models that have become more frequent in this discipline.

Comparison of psychosocial factors between patients with benign fasciculations and those with amyotrophic lateral sclerosis.

In this retrospective study, we compared the initial presentation of patients who were eventually diagnosed with either benign fasciculations (BF) or amyotrophic lateral sclerosis (ALS). We found a significantly higher number of patients with BF reporting a past history of psychiatric symptoms, life stressors, and concurrent psychosomatic symptoms. There was no difference between the two groups in patient report of current anxiety or depression symptoms. These findings support our hypothesis that BF are a manifestation of psychological distress due to somatization and that reviewing psychosocial history is important when patients are being evaluated for fasciculations. Patients seeking medical attention for fasciculations and who do not report a history of underlying psychiatric or psychosomatic disorders should be followed closely as fasciculations have been reported to be a presenting feature of ALS.

Risk for sleep-disordered breathing and executive function in preschoolers.

BACKGROUND: Pediatric sleep-disordered breathing is known to negatively impact cognitive development. While a theoretical basis has been proposed for the developmental effect of pediatric sleep-disordered breathing on executive function specifically, this had not been directly examined among preschool-age children. This population may be particularly vulnerable if school-readiness is compromised. The purpose of the current study was to use a multi-dimensional approach to assessing executive function among preschool-age children at risk for sleep-disordered breathing. METHODS: Thirty-nine preschool children were administered executive function tasks assessing the dimensions of inhibition, working memory, and planning as part of a larger study. A parent or guardian completed a validated questionnaire concerning the child's snoring and other behaviors indicating risk for sleep-disordered breathing. RESULTS: After controlling for age in a series of regressions, higher parent-reported risk for sleep-disordered breathing was associated with substantially lower performance on each executive function dimension. In comparing the group means of children at high and low risk for sleep-disordered breathing, the single snoring frequency item also showed that children who snored frequently or almost always had lower performance on each executive function dimension. CONCLUSIONS: The results suggest that sleep-disordered breathing may be associated with impaired executive function in preschoolers, with its strongest impact on the inhibition dimension, further emphasizing the importance of early intervention for sleep-disordered breathing in this early age group.