Effective Learning Methods for Clinical Skills in Simulation Laboratories: High-Fidelity Mannequins and Standardized Patients

Abstract Background: Many nursing programs are utilizing simulation laboratories to teach clinical skills in a safe environment. Two modes of high-fidelity simulation—high-fidelity mannequins and standardized patients (SPs)—allow for an interactive experience that closely resembles the health care setting. Objectives: The purpose of this integrative literature review was to compare the two high-fidelity simulation methods—high-fidelity mannequins and standardized patients (SPs)—and their benefits when it comes to the development of nursing skills. Furthermore, the paper explored how skills learning laboratories can be optimized. Method: An integrative literature review of 19 research articles was conducted using databases of CINAHL, ERIC, and ProQuest. Search terms included nursing, skills, learning laboratories, undergraduate, baccalaureate, simulation, high-fidelity, mannequins, manikins, and standardized patients. Results: Three benefits were identified in the utilization of high-fidelity mannequins including effective learning and knowledge acquisition, satisfaction with the simulated experience, and improved self-confidence. Four benefits of simulations with standardized patients consisted of improved communication skills, improved clinical judgement, increased confidence, and applicability. Furthermore, common themes of the optimal environments in skill learning laboratories included discussion and engagement, approachable and innovative instructors, and opportunity for practice. Conclusion: Both high-fidelity mannequins and standardized patients give students a closely simulated health care experience. Further studies are needed to directly compare multiple attributes of high-fidelity mannequins and standardized patients. Finally, optimal learning environments were found to be supportive and engaging and led by approachable and innovative instructors

Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis

Malignant melanoma of the urethra is a rare tumour that is difficult to diagnose and treat, resulting in a poor prognosis. In this paper, we present the case of a 65-year-old woman who was referred to a gynaecologist because of a urethral mass that mimicked a caruncle. The tumour was removed by local excision, and a pathological analysis revealed a malignant melanoma. Distal urethrectomy was performed after three months with no evidence of residual tumour. There was no evidence of disease at a six-year followup. In this paper, we compare the epidemiology, treatment, staging, and prognosis of vulvar cancer in general to malignant melanoma of the vulva in particular

Myytti Bosnian kirkosta kansallisten identiteettien rakentamisen välineenä

Tarkastelen pro gradu -työssäni Bosniassa keskiajalla toimineen autonomisen, Bosnian kirkoksi kutsutun kirkkokunnan tutkimusta ja sen taustalla piileviä motiiveja. Bosnian kirkosta tiedetään melko vähän ja sen luonteesta on esitetty useita teorioita. Entisen Jugoslavian alueella tehdyssä tutkimuksessa näiden teorioiden ja tutkijan kansallisen identiteetin välille on usein vedettävissä yhtäläisyysmerkki. Siten serbialainen tutkija päätyy useimmiten siihen lopputulokseen, että Bosnian kirkko oli pohjimmiltaan ortodoksinen, kroatialaisen tutkijan mukaan Bosnian kirkon taustalla oli katolinen kirkko ja bosniakkitutkija löytää Bosnian kirkolle selityksen kerettiläisistä, dualistisista liikkeistä. Olen rajannut aineistoni tutkijoihin, jotka ovat Bosnian kirkon tutkimuksen kannalta merkittävimpiä ja joiden tutkimukset käsittelevät Bosnian kirkkoa eri näkökulmista eri aikakausina. Suurin osa tutkimukseen valikoituneista tutkijoista on entisen Jugoslavian alueelta, mutta lisäksi aineistonani on toiminut John Finen Bosnian kirkkoa ja Bosnian historiaa koskevat tutkimukset ja kirjoitukset. Tutkimukseni lähtökohtana on, että Bosnian kirkon tutkimuksen taustalla vaikuttaa usein selkeät nationalistiset motiivit. Tavoitteena on selvittää, miten tämä ilmenee eri tutkimustraditioissa ja mitä tarkempia poliittisia motiiveja eri tulkintojen taustalta on tunnistettavissa. Lisäksi tavoitteena on esittää, mitä Bosnian kirkosta oikeastaan tiedetään ja mikä on John Finen rooli sen tärkeimpänä modernina tutkijana tässä tutkimustraditiossa. Vertailen tutkimuksessa Bosnian kirkkoa käsittelevää historiantutkimusta tieteenhistoriallisella otteella ja peilaan sitä alkuperämyyttejä ja nationalistista kansakuntien rakentamista koskeviin teorioihin. Tutkimuksen teoreettisen viitekehyksen kannalta keskeinen käsite on historiapolitiikka, eli historiantutkimuksen käyttäminen poliittisten intressien tavoittelussa. Bosnian kirkon tutkimuksessa lähteitä on usein käytetty selvästi tarkoitushakuisesti ja lähdeaineisto on saatettu rajata niin, että se ei olisi ristiriidassa esitetyn teorian kanssa tai sitä on tulkittu jo ennalta asetettua teoriaa tukevasti. Tähän sortuu myös Fine, vaikka hänen tutkimuksensa taustalla ei voida nähdä poliittisia motiiveja. Vaikka Finen tutkimuksessa on puutteensa, on sillä kuitenkin paljon ansioita, joista yhtenä merkittävimpänä voidaan pitää Bosnian varhaishistorian ja gepoliittisen aseman huomioon ottamista. Entisen Jugoslavian alueella teorioilla Bosnian kirkosta on pyritty vahvistamaan omaa kansallista identiteettiä vahvistavia alkuperämyyttejä. Näistä kenties tunnetuin on Bosnian kirkon yhteys Bosnian islamisaatioon. Sen mukaan Bosnian kirkon jäsenet vainottuina kerettiläisinä kääntyivät massoittain islamiin ja siten bosniakit polveutuvat Bosnian kirkon jäsenistä sen sijaan, että olisivat islamisoituneita serbejä tai kroaatteja. Teoriaa Bosnian kirkosta ortodoksisena on käytetty oikeuttamaan ajatus Bosniasta osana Suur-Serbiaa, kun taas teoriaa sen katolilaisesta luonteesta on käytetty tukemaan käsitystä Bosniasta kroaattien kansallisena kehtona. Lisäksi etenkin Kroatiassa 1800 ja 1900-lukujen vaihteessa suosiota saavuttanut panslavismin ideologia on vaikuttanut siihen, että Bosnian kirkon on tulkittu olevan kerettiläinen. Tarkasteltaessa Bosnian kirkon tutkimusta historiapolitiikan käsitteen kautta, voidaan tehdä se johtopäätös, että vaikka Bosnian kirkkoa koskevia tutkimuksia ei välttämättä aina ole suoranaisesti käytetty politiikan välineenä, ovat siihen liittyvät myytit vähintään toissijaisesti olleet erilaisten nationalistisesti motivoituneiden poliittisten näkemysten ja vaatimusten taustalla

Hepatitis C: Host and Viral Factors Associated with Response to Therapy and Progression of Liver Fibrosis

The goal of this study was to identify the baseline host and viral factors of response to antiviral therapy in patients with chronic hepatitis C. Compared with interferon/ribavirin therapy, new current direct-acting antiviral (DAA) combination regimens significantly increased rate of sustained virologic response (SVR) and shorter treatment durations, but is still limited by viral resistance, adverse effects, and high cost especially in developing countries. Human genetic factors and heterogeneity within the HCV genome may be associated with virologic treatment failure before and after antiviral therapy. Further, HCV infection may contribute to the development of HCV-related liver disease and hepatocarcinogenesis, through modulating genetic and epigenetic state of certain genes implicated in control of critical cellular pathways. Previous results confirm the importance of host and viral factors and virus-induced genetic and epigenetic changes in predicting outcome and treatment response

Effects of testing environments and crop density on winter wheat yield

Trabalho final de mestrado integrado em Medicina (Medicina Legal), apresentado à Faculdade de Medicina da Universidade de CoimbraElder abuse is not a recent phenomenon. However, only in the second half of the XX century it has been acknowledged by the scientific community and the society as a whole. This work aims at compiling some of the scientific knowledge acquired over the years, with reference to the most relevant historical aspects, evolution of concepts, definition of abuse topologies, epidemiology and theoretical models. In addition, it addresses the relevance of the shift in paradigm towards viewing violence as a matter of public health, emphasizing the roles that professionals (namely health related) may assume in the battle against elder abuse. Finally, the forensic aspects of dealing with these cases in the context of a medico legal evaluation and the Portuguese judicial system are discussed

The widow maker warning sign or wellens' syndrome: A case report

Wellens' syndrome, also known as LAD (left anterior descending) coronary T-wave syndrome, widow maker or warning sign, is a potentially unrecognized critical proximal LAD stenosis with possible fatal consequences. It can be associated with extensive acute anterior wall myocardial infarction, with left ventricular dysfunction and a lethal outcome within a few days after the onset of symptoms. It usually consists of a typical ECG finding in the precordial leads that represents a significant proximal LAD stenosis in patients with unstable angina pectoris. Although this syndrome is not indicated for PCI (the patient is usually pain-free at the time of electrocardiography registration), it is necessary to recognize the characteristic pattern and perform an emergency coronary angiography and percutaneous or surgical revascularisation of the affected blood vessel. Here we present the case report of a 47 year-old woman without previous anamnesis of coronary disease. On admission to the Coronary Care Unit she was chest pain-free and had all the indicators of Wellens' syndrome

Fractional flow reserve of intermediate lesions on collateral donor coronary arteries after myocardial infarction

Fractional flow reserve (FFR) is the gold standard for the functional assessment of coronary arteries. The aim of this study was to evaluate the relation between angiography, QCA and FFR in borderline lesions on collateral donor coronary arteries. In addition, FFR is compared with the angiographic appearance of collaterals to infarction-related arteries and echocardiographically assessed viability of infarct related the LV wall. In 60 patients with previous IM and occluded IRA, functional assessment of borderline coronary stenosis (30-70% DS) on collaterals donor artery was performed. We have not found statistically significant differences in these parameters between groups with different angiographic appearances of collaterals and different viability of distal myocardium. However, we found higher FFR values in diabetic patients (p=0.018). Higher FFR values in diabetic patients reveal the negative effects of diabetes on collateral growth and myocardial viability

The subchronic effects of 3,4-methylendioxymethamphetamine on oxidative stress in rat brain

The aim of the present study was to evaluate the subchronic effects of 3,4-methylenedioxymethamphetamine on several oxidative stress markers: index of lipid peroxidation (ILP), superoxide dismutase (SOD) activity, superoxide radical (O2.-) levels, and reduced glutathione (GSH) levels in the frontal cortex, striatum and hippocampus of the rat. The study included 64 male Wistar rats (200-250 g). The animals were treated per os with of 5, 10, or 20 mg/kg of 3,4-methylenedioxymethamphetamine (MDMA) every day for 15 days. The subchronic administration of MDMA resulted in an increase in ILP, SOD and O2.-, and a decrease in GSH, from which we conclude that oxidative stress was induced in rat brain

Value-Based Management and Corporate Governance: a Study of Serbian Corporations

The aim of this paper is to determine the place and role of corporate governance and performance measures in the efforts of managers to maximize shareholder value, and the attitude of Serbian corporations toward these issues. The paper first analyses the importance of corporate governance and performance measures in the context of value-based management. Then, through the multiple case study, we investigate the attitude of seven Serbian corporations toward defining the general corporate objective, corporate governance, and performance measurement. Finally, we point out the factors and preconditions that determine corporate culture, objective definition, and performance measures used by Serbian corporations