Efficacia del peer learning sulla capacità di ragionamento diagnostico, sulle capacità decisionali e sulla conoscenza degli studenti di infermieristica: uno studio pilota

Background: Peer learning is an important teaching strategy for nursing students, alongside more tradi-tional approaches, in the development of diagnostic reasoning and critical thinking, leadership, teaching and tutorship skills. Objective: to evaluate the effectiveness of peer learning for nursing students in developing knowledge, diagnostic reasoning and decision making skills. Design: Randomized controlled single-centre pilot study. Setting: Degree Course in nursing in Turin, in June 2019. Participants: Nursing students were 113 (intervention group = 68, control group = 45) . Intervention: The peer learning method was used in sessions attended by 1st, 2nd and 3rd year students simultaneously. These students conducted a clinical case study without teacher supervision. Results: The intervention group students (IG) responded better than those of the control group (CG). Statistically significant differences were found in the percentages of correct answers given to questions requiring diagnostic reasoning (p=0.001; p=0.008). Two students of the intervention group were shown to have competence with regard to nursing diagnosis and to be at a higher level in terms of diagnostic rea-soning skills. Conclusion: Better diagnostic reasoning skills were demonstrated by students in the intervention group. There were, however, few items with statistically significant differences in favour of these stu-dents. This could be attributed to the limited available time for the experimentation and to the small number of students on the degree course.. A formal assessment with certification could also enhance the peer learning experience more than a simple training exercise. The fear of teacher's vote could lead students to a better performance Keywords: peer learning, studenti infermieristici, competenza, ragionamento diagnostico, strategie pedagogiche.Introduzione: L’apprendimento tra pari è una strategia didattica importante, insieme a quelle tradizionali, nello sviluppo di competenze di ragionamento diagnostico e pensiero critico, di leadership, di insegnamento e tutorship degli studenti infermieri. Obiettivo: valutare l’efficacia dell’apprendimento tra pari nello sviluppo delle competenze di ragionamento diagnostico, di capacità decisionale e conoscenza degli studenti infermieri. Disegno: Studio randomizzato controllato monocentrico di tipo pilota. Setting: Sede di un Corso di Laurea in Infermieristica di Torino, nel mese di giugno 2019.Partecipanti: 113 studenti infermieri (gruppo di intervento: n=68, gruppo di controllo: n= 45). Intervento: Applicazione dell’apprendimento tra pari in sessioni in cui erano presenti contemporaneamente studenti del primo, secondo e terzo anno. Questi studenti hanno condotto una discussione di un caso clinico senza la supervisione dei docenti. Risultati: Gli studenti del gruppo di intervento (GI) hanno risposto meglio rispetto al controllo (GC); sono state rilevate differenze statisticamente significative rispetto alle percentuali di correttezza delle risposte ai quesiti di ragionamento diagnostico e capacità decisionale (p=0,001; p=0,008). Rispetto alla diagnosi infermieristica, due studenti del gruppo di intervento hanno dimostrato di possedere questo tipo di competenza. Conclusioni: Gli studenti del GI hanno dimostrato competenze di ragionamento diagnostico più elevate. Sono pochi però gli items nei quali sono emerse differenze statisticamente significative a favore degli studenti del GI. Ciò potrebbe essere attribuito al poco tempo a disposizione della sperimentazione e al numero esiguo di studenti coinvolti nello studio. Una valutazione certificativa, e non solo formativa all’esperienza, potrebbe potenziare ulteriormente l’efficacia dell’apprendimento tra pari. Keywords: “peer learning”, “nursing students”, “competence”, “diagnostic reasoning”, “pedagogic strategie

The effect of the burden of caregiving for people with spinal cord injury (SCI): a cross-sectional study

Aim: To assess the caregiver burden (CB) of caregivers for people with Spinal Cord Injury (SCI) and to examine the psychological impact of the burden of caregiving. Materials and Methods: Cross-sectional study. A set of structured questionnaires was administered to 55 family caregivers of individuals with SCI. The Modified Barthel Index was used to evaluate the independence of care recipients. The Caregiver Burden Inventory was modified and used to assess the CB. The Family Strain Questionnaire – Short Form was administered to measure the psychological impact of CB. The Short Form 36 was used to assess the health status of the participants. Results: CB affects mainly the domains related to time management, the physical condition of caregivers and their sense of personal failure. An increased level of CB and the dependency level of SCI survivors is significantly correlated (p < 0.01) with an increase in the need of psychological support and a decrease in perceived health and quality of life. Conclusions: Caregiving for people with SCI implies the occurrence of CB. The contribution of caregivers should be recognised and supported with tailored relief interventions

Knowledge, Attitudes, and Practices Related to Schistosomiasis Among Children in Northern Senegal

<p>Background</p><p>Schistosomiasis is a highly prevalent parasitic disease in Senegal. The early symptoms are hematuria and dysuria. Children's comprehension of the disease is fundamental to preventing the infection.</p><p>Objectives</p><p>The aim of this study was to investigate the knowledge attitudes, and practices related to schistosomiasis among schoolchildren in 2 rural villages in Northern Senegal and to evaluate their impact on the disease.</p><p>Methods</p><p>A cross-sectional study was conducted. Data about children's knowledge of schistosomiasis, behavior, and preventive measures were collected through a questionnaire.</p><p>Findings</p><p>Questionnaire responses from 575 schoolchildren were analyzed. Correct answers about risky behavior for schistosomiasis were associated with early symptoms ('P' = 0.010). Wearing shoes and washing hands with soap were associated with not having hematuria and dysuria ('P' = 0.007 and 0.049, respectively). Playing in rivers was associated with the aforementioned symptoms (P < 0.001). Children who had good knowledge of schistosomiasis reportedly did not have symptoms ('P' = 0.002). A logistic regression model showed that female sex (odds ratio = 0.35; 'P' = 0.01) and attending a primary school (odds ratio = 0.13; 'P' < 0.001) were significant predictors of a lower risk of the early symptoms of urinary schistosomiasis.</p><p>Conclusions</p><p>This study revealed that the level of knowledge among children in North Senegal about the causes, transmission, prevention, and treatment of schistosomiasis warrants implementing educational intervention

miR-146a-5p impairs melanoma resistance to kinase inhibitors by targeting COX2 and regulating NFkB-mediated inflammatory mediators

BACKGROUND: Targeted therapy with BRAF and MEK inhibitors has improved the survival of patients with BRAF-mutated metastatic melanoma, but most patients relapse upon the onset of drug resistance induced by mechanisms including genetic and epigenetic events. Among the epigenetic alterations, microRNA perturbation is associated with the development of kinase inhibitor resistance. Here, we identified and studied the role of miR-146a-5p dysregulation in melanoma drug resistance.METHODS: The miR-146a-5p-regulated NFkB signaling network was identified in drug-resistant cell lines and melanoma tumor samples by expression profiling and knock-in and knock-out studies. A bioinformatic data analysis identified COX2 as a central gene regulated by miR-146a-5p and NFkB. The effects of miR-146a-5p/COX2 manipulation were studied in vitro in cell lines and with 3D cultures of treatment-resistant tumor explants from patients progressing during therapy.RESULTS: miR-146a-5p expression was inversely correlated with drug sensitivity and COX2 expression and was reduced in BRAF and MEK inhibitor-resistant melanoma cells and tissues. Forced miR-146a-5p expression reduced COX2 activity and significantly increased drug sensitivity by hampering prosurvival NFkB signaling, leading to reduced proliferation and enhanced apoptosis. Similar effects were obtained by inhibiting COX2 by celecoxib, a clinically approved COX2 inhibitor.CONCLUSIONS: Deregulation of the miR-146a-5p/COX2 axis occurs in the development of melanoma resistance to targeted drugs in melanoma patients. This finding reveals novel targets for more effective combination treatment. Video Abstract

Neurosphere-Derived Cells Exert a Neuroprotective Action by Changing the Ischemic Microenvironment

BACKGROUND: Neurosphere-derived cells (NC), containing neural stem cells, various progenitors and more differentiated cells, were obtained from newborn C57/BL6 mice and infused in a murine model of focal ischemia with reperfusion to investigate if: 1) they decreased ischemic injury and restored brain function; 2) they induced changes in the environment in which they are infused; 3) changes in brain environment consequent to transient ischemia were relevant for NC action. METHODOLOGY/PRINCIPAL FINDINGS: NC were infused intracerebroventricularly 4 h or 7 d after 30 min middle cerebral artery occlusion. In ischemic mice receiving cells at 4 h, impairment of open field performance was significantly improved and neuronal loss significantly reduced 7–14 d after ischemia compared to controls and to ischemic mice receiving cells at 7 d. Infusion of murine foetal fibroblast in the same experimental conditions was not effective. Assessment of infused cell distribution revealed that they migrated from the ventricle to the parenchyma, progressively decreased in number but they were observable up to 14 d. In mice receiving NC at 7 d and in sham-operated mice, few cells could be observed only at 24 h, indicating that the survival of these cells in brain tissue relates to the ischemic environment. The mRNA expression of trophic factors such as Insulin Growth Factor-1, Vascular Endothelial Growth Factor-A, Transforming Growth Factor-β1, Brain Derived Neurotrophic Factor and Stromal Derived Factor−1α, as well as microglia/macrophage activation, increased 24 h after NC infusion in ischemic mice treated at 4 h compared to sham-operated and to mice receiving cells at 7 d. CONCLUSIONS/SIGNIFICANCE: NC reduce functional impairment and neuronal damage after ischemia/reperfusion injury. Several lines of evidence indicate that the reciprocal interaction between NC and the ischemic environment is crucial for NC protective actions. Based on these results we propose that a bystander control of the ischemic environment may be the mechanism used by NC to rapidly restore acutely injured brain function

Arterially Perfused Neurosphere-Derived Cells Distribute Outside the Ischemic Core in a Model of Transient Focal Ischemia and Reperfusion In Vitro

BACKGROUND: Treatment with neural stem cells represents a potential strategy to improve functional recovery of post-ischemic cerebral injury. The potential benefit of such treatment in acute phases of human ischemic stroke depends on the therapeutic viability of a systemic vascular delivery route. In spite of the large number of reports on the beneficial effects of intracerebral stem cells injection in experimental stroke, very few studies demonstrated the effectiveness of the systemic intravenous delivery approach. METODOLOGY/PRINCIPAL FINDINGS: We utilized a novel in vitro model of transient focal ischemia to analyze the brain distribution of neurosphere-derived cells (NCs) in the early 3 hours that follow transient occlusion of the medial cerebral artery (MCA). NCs obtained from newborn C57/BL6 mice are immature cells with self-renewal properties that could differentiate into neurons, astrocytes and oligodendrocytes. MCA occlusion for 30 minutes in the in vitro isolated guinea pig brain preparation was followed by arterial perfusion with 1x10(6) NCs charged with a green fluorescent dye, either immediately or 60 minutes after reperfusion onset. Changes in extracellular pH and K(+) concentration during and after MCAO were measured through ion-sensitive electrodes. CONCLUSION/SIGNIFICANCE: It is demonstrated that NCs injected through the vascular system do not accumulate in the ischemic core and preferentially distribute in non-ischemic areas, identified by combined electrophysiological and morphological techniques. Direct measurements of extracellular brain ions during and after MCA occlusion suggest that anoxia-induced tissue changes, such as extracellular acidosis, may prevent NCs from entering the ischemic area in our in vitro model of transitory focal ischemia and reperfusion suggesting a role played by the surrounding microenviroment in driving NCs outside the ischemic core. These findings strongly suggest that the potential beneficial effect of NCs in experimental focal brain ischemia is not strictly dependent on their homing into the ischemic region, but rather through a bystander mechanism possibly mediated by the release of neuroprotective factors in the peri-infarct region

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020