Challenges and Strategies for Building and Maintaining Effective Preceptor-Preceptee Relationships among Nurses

Objectives: This study aimed to determine the challenges encountered and strategies used by nurse preceptors to build effective professional relationships during the preceptorship of final year nursing students. Methods: This study was conducted in November 2012 at the College of Nursing in Sultan Qaboos University, Muscat, Oman. A qualitative research design consisting of focus group discussions was used to investigate the challenges that preceptors encounter and the strategies that they use to build effective relationships with preceptees. A total of 21 preceptors from Sultan Qaboos University Hospital participated in the study as part of a training workshop for nurse preceptors. The interviews were audio recorded, transcribed verbatim and thematically analysed. Results: The main challenges faced by preceptors included discrepancies in applying theory to practice; lack of trust; lack of time, and perceived lack of knowledge. The effective strategies identified by the preceptors to be used in building a healthy preceptor-preceptee relationship were proper orientation; effective communication; preparation for complex situations; appreciation and acknowledgment; positive feedback; assurance of support; spending time together; knowing preceptors personally; giving breaks, and encouraging self-commitment. Conclusion: Preceptors should be encouraged to identify challenges that hinder the building of effective relationships with preceptees early during their preceptorship. The incorporation of appropriate and evidenced-based strategies, such as those identified in this study, can transform the preceptorship experience into one that is fulfilling for both preceptors and preceptees. This may lead to greater job satisfaction, personal and professional growth as well as higher self-esteem levels for preceptors and the realisation of clinical objectives for preceptees

The Role of Prefrontal Cortex in Purchasing Decision-Making Context

The functional role of the prefrontal cortex has often been related to decision-making. Moreover, depending on the task that has to be carried out, it can be even more functionally specialized (Ernst & Paulus, 2005). The dorsolateral prefrontal cortex (DLPFC), for example, seems to be activated by complex tasks solving, working memory processing and recalling of long-lasting memories within long-term memory (Fuster, 2001; Hampson, 2018). Decision-making is applied every day in many different situations, among which stands out the purchasing one. In this context, a crucial and determinant role is played by feelings and emotions. Indeed, emotions are often linked with memories and choices. Previous experiences, in fact, have a key role in this process, since they can influence people\u2019s behavior and take decisions based on some psychological processes such as reward and motivation (Lucchiari & Pravettoni, 2012). However, this is also particularly important when people have to decide within unusual purchasing situations where pros and cons must be taken into account with regard to personal and others\u2019 advantages. In the present study, a modified version of a well-known social interaction paradigm (i.e., the Ultimatum Game; G\ufcth et al., 1982) was used. The scenarios proposed described a store experience in which they should imagine using vouchers. Choices could be neutral, advantageous or disadvantageous from the participant\u2019s perspective. In order to explore the hemodynamic response, fNIRS was used by applying a 18-channels array of optodes covering prefrontal and frontal areas. The final sample included 32 university students of comparable age and educational level. Results showed that the specific offer type led to the engagement of dedicated neural networks, with increased activation of the right medial prefrontal cortex in the case of disadvantageous expenses. Findings are discussed taking into account the psychological factors involved in each purchase choice

Decision-Making in Economic and Moral Contexts : evidence from Social Neuroscience

Decision-making is configured as a very complex construct that it is influenced by different variables (Rilling & Sanfey, 2011; Fehr & Camerer 2007; Wang, Liu, & Ruhe, 2004) such as emotions and cognitive evaluation (Frith & Singer 2008; Sanfey, Loewenstein, McClure, & Cohen, 2006; Groot et al., 2017; Stallen, Smidts, A., & Sanfey, 2013), that allows individuals to consider personal interests, possible losses or rewards, and the ethical and moral choices implications. Specifically, this study aimed to evaluate the decision-making on a sample of 32 participants who were asked to make choices in two different action contexts: economic and moral. To this aim, a task, consisting of a modified version of the Ultimatum Game was administered to evaluate participants\u2019 choices. Specifically, the economic context proposed to divide a sum of money provided as compensation for a work done together; while the moral context proposed to support a colleague\u2019s family who is facing health issues. Within the two conditions three types of offers were presented: neutral, advantageous or disadvantageous. In the neutral condition, an offer was proposed that provided for a fair sharing of money between the two parties, in the advantageous condition a favorable offer was proposed for the subject, and finally, in the disadvantageous condition, the opposite occurred. Participants' neural activity was recorded continuously through the use of near-infrared functional spectroscopy (fNIRS). The levels of oxygenated (O2Hb) and deoxygenated (HHb) hemoglobin were observed in the prefrontal cortex (Gabay, Radua, Kempton, & Mehta, 2014; Rogers, Hazlewood, Blevis, & Lim, 2004; Phan, Wager, Taylor, & Liberzon, 2002). Results showed the recruitment of distinct and specific neural networks within the prefrontal and frontal areas, according to the different conditions and offer types. Results will be discussed by framing the different scenarios with some psychological, motivational and social issues related to decision-making

Quantitative assessment of HCC wash-out on CT is a predictor of early complete response to TACE

OBJECTIVES: To investigate the predictive value of four-phase contrast-enhanced CT (CECT) for early complete response (CR) to drug-eluting-bead transarterial chemoembolization (DEB-TACE), with a particular focus on the quantitatively assessed wash-in and wash-out. METHODS: A retrospective analysis of preprocedural CECTs was performed for 129 HCC nodules consecutively subjected to DEB-TACE as first-line therapy. Lesion size, location, and margins were recorded. For the quantitative analysis, the following parameters were computed: contrast enhancement ratio (CER) and lesion-to-liver contrast ratio (LLC) as estimates of wash-in; absolute and relative wash-out (WO(abs) and WO(rel)) and delayed percentage attenuation ratio (DPAR) as estimates of wash-out. The early radiological response of each lesion was assessed by the mRECIST criteria and dichotomized in CR versus others (partial response, stable disease, and progressive disease). RESULTS: All quantitatively assessed wash-out variables had significantly higher rates for CR lesions (WO(abs) p = 0.01, WO(rel) p = 0.01, and DPAR p = 0.00002). However, only DPAR demonstrated an acceptable discriminating ability, quantified by AUC = 0.80 (95% CI0.73–0.88). In particular, nodules with DPAR ≥ 120 showed an odds ratio of 3.3(1.5–7.2) for CR (p = 0.0026). When accompanied by smooth lesion margins, DPAR ≥ 120 lesions showed a 78% CR rate at first follow-up imaging. No significative association with CR was found for quantitative wash-in estimates (CER and LLC). CONCLUSIONS: Based on preprocedural CECT, the quantitative assessment of HCC wash-out is useful in predicting early CR after DEB-TACE. Among the different formulas for wash-out quantification, DPAR has the best discriminating ability. When associated, DPAR ≥ 120 and smooth lesion margins are related to relatively high CR rates. KEY POINTS: • A high wash-out rate, quantitatively assessed during preprocedural four-phase contrast-enhanced CT (CECT), is a favorable predictor for early radiological complete response of HCC to drug-eluting-bead chemoembolization (DEB-TACE). • The arterial phase of CECT shows great dispersion of attenuation values among different lesions, even when a standardized protocol is used, limiting its usefulness for quantitative analyses. • Among the different formulas used to quantify the wash-out rate (absolute wash-out, relative wash-out, and delayed percentage attenuation ratio), the latter (DPAR), based only on the delayed phase, is the most predictive (AUC = 0.80), showing a significant association with complete response for values above 120

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear. Objective: To identify factors associated with increased risk of recurrence. Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes. Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013). Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs

The benefit of image guidance for the contralateral interhemispheric approach to the lateral ventricle

OBJECTIVES: Recently, neurosurgeons have increasingly faced small intracerebral lesions in asymptomatic or minimally symptomatic patients. Here, we evaluated a series of four patients with nearly asymptomatic intraventricular tumors close to the corpus callosum that had been treated with the aid of an image-guided transcallosal approach. PATIENTS AND METHODS: Four consecutive patients suffering from left intra- and paraventricular tumors were operated on via a contralateral interhemispheric transcallosal approach with the aid of neuronavigation. Our image-guided system directed: (1) the skin incision, (2) the interhemispheric dissection, and (3) the incision of the corpus callosum. RESULTS: Using the image-guided contralateral interhemispheric transcallosal approach to the left ventricle all lesions have been completely resected without the risk of damage to the dominant hemisphere. The callosal incision was kept as limited as possible (1.2-2.1cm) depending on the size of the tumor. No postoperative neurological or neuropsychological deficit was observed in our series. CONCLUSION: Neuronavigation facilitates a safe and targeted contralateral interhemispheric transcallosal approach to the dominant hemisphere's lateral ventricle. Our technique minimizes the risk of damage to the dominant hemisphere and requires only a limited opening of the corpus callosum, which might decrease the risk of neuropsychological morbidity

Gender Differences and Unfairness Processing during Economic and Moral Decision-Making : A fNIRS Study

Decisional conflicts have been investigated with social decision-making tasks, which represent good models to elicit social and emotional dynamics, including fairness perception. To explore these issues, we created two modified versions of the UG framed within an economic vs. a moral context that included two kinds of unfair offers: advantageous (upside, U) or disadvantageous (downside, D) from the responder\u2019s perspective, and vice-versa for the proponent. The hemodynamic activity of 36 participants, 20 females and 16 males, was continuously recorded with fNIRS to investigate the presence of general or specific circuits between the different experimental conditions. Results showed that disadvantageous offers (D) are associated with an increased widespread cortical activation. Furthermore, we found that advantageous moral choices at the expense of others (U) were related to the activation of the right prefrontal cortex. Finally, we found gender-related differences in brain activations in the different frameworks. In particular, the DLPFC was recruited by females during the economic task, and by males during the moral frame. In conclusion, the present study confirmed and expanded previous data about the role of the prefrontal cortices in decision-making, suggesting the need for further studies to understand better the different prefrontal networks serving moral and economic decisions also considering gender-related differences