Effectiveness of Using a Self-Directed Learning Program to Teach Physical Examination and Health Assessment Skills: A Quasi-Experimental Study.

BACKGROUND: Conducting health assessments and physical examinations are essential skills for independent practice. Exploring how to teach these skills effectively is essential. PURPOSE: This study was designed to validate the effectiveness of a self-directed learning program in improving nursing student outcomes in terms of their learning health assessment and physical examination skills. METHOD: A quasi-experimental design was used, and second-year nursing students enrolled in a health assessment and physical examination course at a university of science and technology in central Taiwan were recruited using purposive sampling. Both the control and experimental groups were taught using a traditional teaching method. The experimental group additionally participated in a self-directed learning program. Structured questionnaires, including the Chinese version of the Self-Directed Learning Readiness Scale, Scales of Motivation and Learning Strategies, Interpersonal Skills Assessment Tool, the Course Satisfaction Evaluation Scale, and the Perception of Health Assessment and Physical Examination Competence Scale, were used to collect data at three time points. RESULTS: After controlling for the effects of pretest scores, after the intervention, the experimental group achieved significantly higher scores than the control group for self-directed learning (creative learning and love of learning), learning motivation (goal orientation, work value, expected success, and test anxiety), and cognitive strategies (total score, elaboration strategy, recitation strategy, and monitoring strategy). In addition, the health assessment exercise improved interpersonal and communication skills, and learning satisfaction was significantly higher in the experimental group than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A physical examination and health assessment course designed using the self-directed learning framework can effectively improve student competence in related skills to enhance their ability to assess patient health problems in clinical settings. This study presents an alternative approach to teaching health assessment and physical examination courses and validates the positive effect of this approach on student learning outcomes.

Hydration, barrier of skin and uremic pruritus in patients undergoing hemodialysis: A pilot investigation.

BACKGROUND: Chronic kidney disease-associated pruritus is a common symptom for patients with end-stage renal disease on hemodialysis; however, its pathogenesis remains poorly understood. Chronic kidney disease-associated pruritus has been reported to be associated with skin hydration or barrier. Thus, an interaction or association may be observed between chronic kidney disease-associated pruritus, skin hydration, and skin barrier. PURPOSE: This study aimed to investigate the association between chronic kidney disease-associated pruritus, skin hydration, and skin barrier in patients with hemodialysis. METHODS: This cross-sectional study was conducted between November 2018 and February 2019. It included 162 patients undergoing maintenance hemodialysis for at least 6 months. Data were collected using the 5-D Itch Scale. Skin hydration and skin barrier were measured according to stratum corneum hydration and transepidermal water loss. RESULTS: Pruritus occurred in 42% of patients with hemodialysis. The mean 5-D Itch Scale severity was 10.91±4.5. Pearson correlation analysis revealed that pruritus significantly correlated with moisture level (r=0.191; P=0.01), stratum corneum hydration (r=0.191; P=0.01), barrier strength (r=-0.162; P=0.04), and transepidermal water loss (r=0.162; P=0.04). CONCLUSION: Chronic kidney disease-associated pruritus remains a serious problem in patients undergoing hemodialysis, and stratum corneum hydration and transepidermal water loss are among its causes. This study illustrates the importance of skin hydration and barrier and sensitization to chronic kidney disease-associated pruritus. Therefore, the possible risk factors of chronic kidney disease-associated pruritus must be monitored closely in patients at risk.

Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study.

Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan provides biennial mammogram tests for all women aged 45 to 69 years. A recommendation for further investigation is sent via post to women with a BI-RADS result of 0. The proportion of women who followed-up with a recall request for further investigation after an abnormal mammogram has been below 92.5% in recent years. Therefore, we aimed to explore the experiences of these women who refused recall for further investigation despite an abnormal mammogram. Purposive sampling was conducted on 13 women who refused recall for further examination of abnormal screening mammograms. Data collection included inductive, in-depth interviews or telephone interviews. A content analysis was applied. Three themes were identified: (1) negative screening experiences, (2) struggling with 'to go or not to go', and (3) rationalizing without a follow-up examination. The first theme included three subthemes: (1) pain of examination, (2) the inconvenience of medical treatment; waiting, and (3) dissatisfaction with having to pay for further examination. The second major theme included three subthemes: (1) perceiving one's susceptibility to breast cancer as very low, (2) questioning the accuracy of the results, and (3) procrastinating with a "head-in-the-sand" mentality. The third major theme included two subthemes: (1) fatalism and (2) paying attention to self-cultivation. In conclusion, the findings provide important information to healthcare providers involved in case management related to the actual living experiences of women with abnormal screening mammogram results and the additional education required to raise breast cancer awareness in the general public to achieve overall caring goals.

The Mechanism of the Zika Virus Crossing the Placental Barrier and the Blood-Brain Barrier.

Zika virus (ZIKV) infection causes severe neurological symptoms in adults and fetal microcephaly and the virus is detected in the brain of microcephaly and meningoencephalitis patient. However, the mechanism of ZIKV crossing the physiological barrier to the central nervous systems (CNS) remains elusive. The placental barrier and the blood brain barrier (BBB) protect the fetus from pathogens and ensure healthy brain development during pregnancy. In this study, we used human placenta trophoblasts cells (JEG-3) and human brain-derived endothelial cells (hCMEC/D3) as in vitro models of the physiological barriers. Results showed that ZIKV could infect JEG-3 cells effectively and reduce the amounts of ZO-1 and occludin between adjacent cells by the proteasomal degradation pathway, suggesting that the permeability of the barrier differentially changed in response to ZIKV infection, allowing the virus particle to cross the host barrier. In contrast, ZIKV could infect hCMEC/D3 cells without disrupting the BBB barrier permeability and tight junction protein expression. Although no disruption to the BBB was observed during ZIKV infection, ZIKV particles were released on the basal side of the BBB model and infected underlying cells. In addition, we observed that fluorescence-labeled ZIKV particles could cross the in vitro placenta barrier and BBB model by transcytosis and the action of transcytosis could be blocked by either low temperature or pharmacological inhibitors of endocytosis. In summary, the ZIKV uses a cell-type specific paracellular pathway to cross the placenta monolayer barrier by disrupting cellular tight junction. In addition, the ZIKV can also cross both the placenta barrier and the BBB by transcytosis. Our study provided new insights into on the mechanism of the cellular barrier penetration of ZIKV particles.

Effects of Massage on Blood Pressure in Patients With Hypertension and Prehypertension: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Massage may help reduce blood pressure; previous studies on the effect of massage on blood pressure have presented conflicting findings. In addition, no systematic review is available. OBJECTIVE: The aim of this study was to evaluate the evidence concerning the effect of massage on blood pressure in patients with hypertension or prehypertension. METHODS: A search was performed on electronic database records up to October 31, 2013, based on the following medical subject headings or keywords: hypertension, massage, chiropractic, manipulation, and blood pressure. The methodological quality of randomized controlled trials was assessed based on the Cochrane collaboration tool. A meta-analysis was performed to evaluate the effect of massage on hypertension. The study selection, data extraction, and validation were performed independently by 2 reviewers. RESULTS: Nine randomized controlled trials met our inclusion criteria. The results of this study show that massage contributes to significantly enhanced reduction in both systolic blood pressure (SBP) (mean difference, -7.39 mm Hg) and diastolic blood pressure (DBP) (mean difference, -5.04 mm Hg) as compared with control treatments in patients with hypertension and prehypertension. The effect size (Hedges g) for SBP and DBP was -0.728 (95% confidence interval, -1.182 to -0.274; P = .002) and -0.334 (95% confidence interval, -0.560 to -0.107; P = .004), respectively. CONCLUSION: This systematic review found a medium effect of massage on SBP and a small effect on DBP in patients with hypertension or prehypertension. High-quality randomized controlled trials are urgently required to confirm these results, although the findings of this study can be used to guide future research.

Development and validation of the Simulation Learning Effectiveness Inventory.

AIM: To develop and psychometrically test the Simulation Learning Effectiveness Inventory. BACKGROUND: High-fidelity simulation helps students develop clinical skills and competencies. Yet, reliable instruments measuring learning outcomes are scant. DESIGN: A descriptive cross-sectional survey was used to validate psychometric properties of the instrument measuring students' perception of stimulation learning effectiveness. METHODS: A purposive sample of 505 nursing students who had taken simulation courses was recruited from a department of nursing of a university in central Taiwan from January 2010-June 2010. The study was conducted in two phases. In Phase I, question items were developed based on the literature review and the preliminary psychometric properties of the inventory were evaluated using exploratory factor analysis. Phase II was conducted to evaluate the reliability and validity of the finalized inventory using confirmatory factor analysis. RESULTS: The results of exploratory and confirmatory factor analyses revealed the instrument was composed of seven factors, named course arrangement, equipment resource, debriefing, clinical ability, problem-solving, confidence and collaboration. A further second-order analysis showed comparable fits between a three second-order factor (preparation, process and outcome) and the seven first-order factor models. Internal consistency was supported by adequate Cronbach's alphas and composite reliability. Convergent and discriminant validities were also supported by confirmatory factor analysis. CONCLUSION: The study provides evidence that the Simulation Learning Effectiveness Inventory is reliable and valid for measuring student perception of learning effectiveness. The instrument is helpful in building the evidence-based knowledge of the effect of simulation teaching on students' learning outcomes.

Factors associated with gender differences in medication adherence: a longitudinal study.

AIMS: To examine gender differences in the medication adherence of patients with hypertension by applying a longitudinal follow-up. BACKGROUND: Patient views of illness affect their adherence to therapeutic regimens. However, few studies have explored these issues by using a longitudinal design or from a gender perspective. DESIGN: This study used a longitudinal, correlational design. METHODS: A purposive sampling of 118 patients were recruited from cardiovascular clinics of a teaching hospital in Central Taiwan in 2007-2009. Data were collected using the Chinese Illness Perception Questionnaire-Revised and the Medication Adherence Inventory at three time points: at the first clinic visit, 6 and 12 months after the initial survey. Generalized estimating equations were calculated using the STATA software for data analysis. RESULTS: The findings revealed that male patients adhere more effectively to medications than female patients do. The interaction between systolic blood pressure and gender emerged as a significant predictor of adherence. Factors associated with adherence in male patients included less causal attribution to culture, more attribution to risk factors, fewer symptoms and uncertain symptoms related to high blood pressure, lower scores for timeline-cyclical and higher scores for illness consequences and coherence. Medication adherence for female patients was significantly related to more causal attribution to balance and risk factors, less personal control and enhanced illness coherence. CONCLUSION: Factors associated with adherence to antihypertensive medication were relatively gender-specific. Awareness of the differences is crucial for health professionals to provide appropriate advice for patients to cope effectively with their health threat.

Associations among depression, obesity, and metabolic syndrome in young adult females.

Depression may be a risk factor for obesity or metabolic syndrome. The aims of this study were to determine the relationships among depression, obesity, and metabolic syndrome in young adult females as well as the role of depression in the components of metabolic syndrome. A cross-sectional study was conducted on 323 young adult females. Demographic characteristics, anthropometric measurements, and laboratory values were collected. The criteria of the Bureau of Health Promotion, Department of Health, Taiwan, were used to define metabolic syndrome. Depression was measured using the Center for Epidemiologic Studies Depression scale. The prevalence of depression in the sample was 17%, that of overweight and obesity was 17%, and that of metabolic syndrome was 6.8%. Depression showed significant associations with high body mass index (BMI), increased waist circumference and blood pressure (BP), and overweight and obesity (ß = 0.15, odds ratio [OR] = 1.17, 95% confidence interval [CI] = [1.11, 1.23], p < .001). No associations were observed between depression and metabolic syndrome (ß = -0.01, OR = 0.99, 95% CI = [0.92, 1.06], p = .69) or any of its individual components after adjustment for BMI and demographic variables. The findings show that depression was associated with increasing odds of overweight and obesity in young adult females and may also have increased the physiological risk associated with metabolic syndrome. Early detection of depression and obesity as part of metabolic syndrome is important in the health management of young adult females for decreasing the risks of cardiovascular disease and diabetes.

[The development and current status of high-fidelity patient simulation teaching].

High-fidelity patient simulation teaching represents one of the most important innovations in healthcare education in the past two decades. In Taiwan, many medical centers and medical colleges now have clinical skill centers equipped with a high-fidelity patient simulator. Practicing clinical scenarios in this simulated environment can help strengthen students' professional essentials and competencies outside of classroom and clinical teaching settings. High-fidelity simulation teaching is an integrated teaching strategy that is continuing to receive greater attention. This article describes the historical development of high-fidelity patient simulation teaching, its current status, and applications in nursing education as a reference for nursing educators.

The longitudinal effect of concept map teaching on critical thinking of nursing students.

Concept map is a useful cognitive tool for enhancing a student's critical thinking by encouraging students to process information deeply for understanding. However, there is limited understanding of longitudinal effects of concept map teaching on students' critical thinking. The purpose of the study was to investigate the growth and the other factors influencing the development of critical thinking in response to concept map as an interventional strategy for nursing students in a two-year registered nurse baccalaureate program. The study was a quasi-experimental and longitudinal follow-up design. A convenience sample was drawn from a university in central Taiwan. Data were collected at different time points at the beginning of each semester using structured questionnaires including Critical Thinking Scale and Approaches to Learning and Studying. The intervention of concept map teaching was given at the second semester in the Medical-Surgical Nursing course. The results of the findings revealed student started with a mean critical thinking score of 41.32 and decreased at a rate of 0.42 over time, although not significant. After controlling for individual characteristics, the final model revealed that the experimental group gained a higher critical thinking score across time than the control group. The best predictive variables of initial status in critical thinking were without clinical experience and a higher pre-test score. The growth in critical thinking was predicted best by a lower pre-test score, and lower scores on surface approach and organized study. Our study suggested that concept map is a useful teaching strategy to enhance student critical thinking.

Effects of concept map teaching on students' critical thinking and approach to learning and studying.

The purpose of this study was to explore the effects of concept mapping in developing critical thinking ability and approach to learning and studying. A quasi-experimental study design with a purposive sample was drawn from a group of nursing students enrolled in a medical-surgical nursing course in central Taiwan. Students in the experimental group were taught to use concept mapping in their learning. Students in the control group were taught by means of traditional lectures. After the intervention, the experimental group had better overall critical thinking scores than did the control group, although the difference was not statistically significant. After controlling for the effects of age and the pretest score on critical thinking using analysis of covariance, the experimental group had significantly higher adjusted mean scores on inference and overall critical thinking compared with the control group. Concept mapping is an effective tool for improving students' ability to think critically.

Effects of liner stiffness for trans-tibial prosthesis: a finite element contact model.

The socket liner plays a crucial role in redistribution of the interface stresses between the stump and the socket, so that the peak interface stress could be reduced. However, how the peak stress is affected by various liner stiffnesses is still unknown, especially when the phenomenon of the stump slide within the socket is considered. This study employed nonlinear contact finite element analyses to study the biomechanical reaction of the stump sliding with particular attention to the liner stiffness effects of the trans-tibial prosthesis. To validate the finite element outcomes, experimental measurements of the interface stresses and sliding distance were further executed. The results showed that the biomechanical response of the stump sliding are highly nonlinear. With a less stiff liner, the slide distance of the stump would increase with a larger contact area. However, this increase in the contact area would not ensure a reduction in the peak interface stress and this is due to the combined effects of the non-uniform shape of the socket and the various sliding distances generated by the different liner stiffnesses.