The Impact of Simulation Sequencing on Perceived Clinical Decision Making

An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students\u27 perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources

Latina Adolescents\u27 Perspectives on Relationships

Objective: To explore adolescent Latinas’perspectives on relationships and generate knowledge to inform interventions. Setting: Seven Latina adolescents participated. Design: This qualitative study was guided by principles of community-based participatory research and utilized the photovoice method. Method: Participants took photos depicting elements of relationships and participated in guided discussions. They identified and named five elements of healthy relationships. Results: The five elements included commitment, communication, faith, amigos y amores (friends and lovers) and play. These elements occur across all forms of relationships. Conclusion: The results revealed important information that may be used to tailor health promotion interventions for Latina/o youth

Cancer Biology

This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist focuses on DNA mutations that cause cancer, abnormal regulation of cell growth and death, and metastasis. Updated March 2016 version posted March 28, 2017.https://escholarship.umassmed.edu/cancer_concepts/1005/thumbnail.jp

The Pathology of Cancer

Patients and physicians depend on pathologists to make the diagnosis of cancer and of the specific type of cancer. Pathologists are expert in pattern recognition and in the natural history of diseases, including cancers. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe the pathology of cancer.https://escholarship.umassmed.edu/cancer_concepts/1023/thumbnail.jp

The Impact of Supplemental Simulation on Newly Licensed Registered Nurses

Background Challenges exist for nursing students as they transition to their role as newly licensed registered nurses (NLRNs) due to a mismatch between their perceived readiness and role competency and the demands of the practice environment. Simulations with debriefing may be one strategy to better prepare students for the role of a NLRN. The purpose of this study was to explore whether supplementing traditional clinical experiences with simulation versus substituting simulation for traditional clinical experiences had an impact on NLRNs\u27 perception of competence, work stress, and job satisfaction. Sample A convenience sample of 115 NLRNs from two successive graduating classes in a Midwestern traditional baccalaureate nursing program who participated in the same curriculum with different uses of simulation were recruited. Methods A quasi-experimental design was used to compare the two groups of NLRNs at six months of practice. Results The NLRNs with supplemented simulation had higher job satisfaction. Conclusion These results suggest that programs that use simulation to supplement traditional clinical experiences may lead to increased job satisfaction in NLRNs

Clinicopathologic consensus study of gray zone lymphoma with features intermediate between DLBCL and classical HL

Gray zone lymphoma (GZL) is described as sharing features with classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL). However, there remains complexity in establishing diagnosis, delineating prognosis, and determining optimum therapy. Sixty-eight cases diagnosed as GZL across 15 North American academic centers were evaluated by central pathology review to achieve consensus. Of these, only 26 (38%) were confirmed as GZL. Morphology was critical to GZL consensus diagnosis (eg, tumor cell richness); immunohistochemistry showed universal B-cell derivation, frequent CD30 expression, and rare Epstein-Barr virus (EBV) positivity (CD20(+), 83%; PAX5(+), 100%; BCL6(+), 20%; MUM1(+), 100%; CD30(+), 92%; EBV(+), 4%). Forty-two cases were reclassified: nodular sclerosis (NS) cHL, n = 27 (including n = 10 NS grade 2); lymphocyte predominant HL, n = 4; DLBCL, n = 4; EBV(+) DLBCL, n = 3; primary mediastinal large BCL n = 2; lymphocyte-rich cHL and BCL-not otherwise specified, n = 1 each. GZL consensus-confirmed vs reclassified cases, respectively, more often had mediastinal disease (69% vs 41%; P = .038) and less likely more than 1 extranodal site (0% vs 25%; P = .019). With a 44-month median follow-up, 3-year progression-free survival (PFS) and overall survival for patients with confirmed GZL were 39% and 95%, respectively, vs 58% and 85%, respectively, for reclassified cases (P = .19 and P = .15, respectively). Interestingly, NS grade 2 reclassified patients had similar PFS as GZL consensus-confirmed cases. For prognostication of GZL cases, hypoalbuminemia was a negative factor (3-year PFS, 12% vs 64%; P = .01), whereas frontline cyclophosphamide, doxorubicin, vincristine, and prednisone +/- rituximab (CHOP+/-R) was associated with improved 3-year PFS (70% vs 20%; P = .03); both factors remained significant on multivariate analysis. Altogether, accurate diagnosis of GZL remains challenging, and improved therapeutic strategies are needed

The Impact of Nutrition, Helminth Infection, and Lifestyle on Elementary School Student's Achievement

There is a lot of helminth infections and malnutrition cases in Indonesia. Some of the effects of helminth infection are anemia, diarrhea, malnutrition, intestinal obstruction, growth and developmental disorder, and also cognitive impairment. This study aimed to explore the impact of nutrition, helminth infection, and lifestyle on elementary school students' achievement. An observational analytical study with the cross-sectional design was used. The study was participated by 65 elementary school students grade 3, 4, and 5. The study was conducted in Pasir Panjang Elementary School, Kupang, Nusa Tenggara Timur, Indonesia. The data was analyzed using chi-square. There were 7 students (10.77%) having helminth infections:4 students (57.1%) had Ascarislumbricoides infection, 2 students (28.6%) had Enterobius vermicularis infection, and 1 student (14.3%) had Strongyloides stercoralis infection. There were no differences found on students' achievement between students with normal and low nutritional state (p = 0.917; p > 0.05) and between different lifestyle habit (p = 0.768; p > 0.05). However, a significant difference in students' achievement was found between students with and without helminth infection (p = 0.036; p < 0.05). Helminth infection had a significant impact on elementary school students' achievement, but no significant impact found for differences in nutritional state and lifestyle habit

Nursing Student Perceptions Regarding Simulation Experience Sequencing

BACKGROUND: The use of simulated learning experiences (SLEs) have increased within nursing curricula with positive learning outcomes for nursing students. The purpose of this study is to explore nursing students\u27 perceptions of their clinical decision making (CDM) related to the block sequencing of different patient care experiences, SLEs versus hospital-based learning experiences (HLEs). METHOD: A qualitative descriptive design used open-ended survey questions to generate information about the block sequencing of SLEs and its impact on nursing students\u27 perceived CDM. RESULTS: Three themes emerged from the data: Preexperience Anxiety, Real-Time Decision Making, and Increased Patient Care Experiences. CONCLUSION: Nursing students identified that having SLEs prior to HLEs provided several benefits. Even when students preferred SLEs prior to HLEs, the sequence did not impact their CDM. This suggests that alternating block sequencing can be used without impacting the students\u27 perceptions of their ability to make decisions

Centrosome defects and genetic instability in malignant tumors

Genetic instability is a common feature of many human cancers. This condition is frequently characterized by an abnormal number of chromosomes, although little is known about the mechanism that generates this altered genetic state. One possibility is that chromosomes are missegregated during mitosis due to the assembly of dysfunctional mitotic spindles. Because centrosomes are involved in spindle assembly, they could contribute to chromosome missegregation through the organization of aberrant spindles. As an initial test of this idea, we examined malignant tumors for centrosome abnormalities using antibodies to the centrosome protein pericentrin. We found that centrosomes in nearly all tumors and tumor-derived cell lines were atypical in shape, size, and composition and were often present in multiple copies. In addition, virtually all pericentrin-staining structures in tumor cells nucleated microtubules, and they participated in formation of disorganized mitotic spindles, upon which chromosomes were missegregated. All tumor cell lines had both centrosome defects and abnormal chromosome numbers, whereas neither was observed in nontumor cells. These results indicate that centrosome defects are a common feature of malignant tumors and suggest that they may contribute to genetic instability in cancer