e-Delphi Technique in Postgraduate Registered Nursing Education and Competency Development: A Scoping Review

Background: It is common for nursing programs in Canada to hire part-time clinical instructors (CIs) to teach the practical components of curricula. Although experts in their field, these Registered Nurses (RNs) don’t have any formal preparation in education. Additionally, there are no current established competencies for CIs in Canada. This void in the Canadian literature warrants a search of competency development using the e-Delphi technique. The e-Delphi technique is a commonly used surveying technique for competency development in healthcare. Objective: To understand the extent, range, and nature of evidence of the use of the e-Delphi technique and critically appraise its use in postgraduate nursing education and nursing competency development to establish the feasibility of application to clinical nurse educator competency (CNEC) development in Canada. Methods: Two independent researchers conducted a scoping review to determine the extent, range, and nature of evidence of the use of the e-Delphi technique and critically appraise its use in postgraduate nursing education and nursing competency development. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute Reviewers’ Manual were used to guide the review. Results: The main components of e-Delphi that were extracted from the literature for review included the purposes of the studies, background of expert panel members, methods of e-Delphi used, reported level of consensus, number of rounds to meet consensus, time between rounds of questions, number of participants and changing participants. The purposes of the reviewed studies demonstrated that e-Delphi is a preferred method for developing or revising competencies for post baccalaureate programs. However, the other key components that were extracted revealed much variation in the use of e-Delphi by researchers. Most importantly, researchers need to ensure they report on the backgrounds of the expert panel members, decrease the time between the survey rounds and avoid introducing new participants in later rounds of the surveys to ensure consistency and methodological rigour of e-Delphi. Conclusion: There are variations in how e-Delphi is used in the literature for competency development, but if the authors are transparent with all phases of the method used, it is evident that it can significantly contribute to the advancement of future CNEC development in Canada. Résumé Contexte : Il est courant pour les programmes de formation en sciences infirmières au Canada d’embaucher des formatrices et formateurs cliniques à temps partiel pour enseigner les composantes pratiques des programmes d’études. Bien que spécialistes dans leur domaine, ces infirmières et infirmiers ne détiennent aucune formation formelle en enseignement. De plus, il n’existe actuellement aucun référentiel de compétences établi pour les formatrices et formateurs cliniques au Canada. Ce vide dans les écrits canadiens justifie une recherche sur l’élaboration des compétences liées à la formation clinique à l’aide de la méthode e-Delphi, une technique de sondage en ligne fréquemment utilisée pour nommer et clarifier les compétences dans le domaine de la santé. Objectif : Comprendre l’étendue, la portée et la nature des données probantes de l’utilisation de la méthode e-Delphi et évaluer de manière critique son utilisation dans la formation après l’obtention du grade en sciences infirmières ainsi que le développement des compétences infirmières afin d’établir la faisabilité de l’application pour l’élaboration des compétences des formatrices et formateurs cliniques au Canada. Méthodes : Deux chercheuses indépendantes ont mené une revue de la portée pour déterminer l’étendue, l’éventail et la nature des données probantes de l’utilisation de la méthode e-Delphi et évaluer de manière critique son utilisation dans la formation après l’obtention du grade en sciences infirmières et le développement des compétences infirmières. Le Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR]) et le Joanna Briggs Institute Reviewers’ Manual ont été utilisés pour guider cette revue. Résultats : Les principales composantes de la méthode e-Delphi qui ont été extraites de la littérature pour la revue comprenaient les objectifs des études, les antécédents des membres du groupe d’experts, les méthodes e-Delphi utilisées, le niveau de consensus rapporté, le nombre de tours pour atteindre le consensus, le temps entre les tours de questions, ainsi que le nombre et les changements de participants. Les objectifs des études examinées ont démontré que la méthode e-Delphi est privilégiée pour développer ou réviser des compétences pour les programmes post-baccalauréat. Cependant, les autres composantes clés extraites ont révélé une grande variation dans l’utilisation de la méthode e-Delphi par les groupes de recherche. Plus important encore, ces derniers doivent s’assurer de rapporter les antécédents des membres du panel d’experts, de réduire le temps entre les cycles de sondage et d’éviter d’introduire de nouveaux participants dans les cycles ultérieurs des sondages afin d’assurer la cohérence et la rigueur méthodologique de la méthode e-Delphi. Conclusion : Il existe des variations dans la façon dont la méthode e-Delphi est utilisée et rapportée dans la littérature pour le développement des compétences, mais si il y a transparence à toutes les phases de l’utilisation de la méthode, il est évident qu’elle peut contribuer de manière significative à l’élaboration du futur référentiel des compétences des formatrices et formateurs cliniques au Canada

Los nódulos de Schmorl y sus implicancias en la salud de una población histórica colonial : (Mendoza, Argentina)

Los nódulos de Schmorl (NS) son lesiones que afectan la columna vertebral. Si bien su etiología es diversa, han sido interpretados como una lesión posiblemente asociada con la actividad física. En este trabajo se analiza la prevalencia de NS en cincuenta y dos esqueletos adultos del Área Fundacional de Mendoza correspondientes a los siglos XVII-XIX. Se discute su prevalencia en combinación con el desarrollo de osteofitosis marginal según sexo, edad, sectores socio-económicos y periodos cronológicos. Se registró una prevalencia de 21,1% para el total de los esqueletos analizados. Aunque no puede descartarse la incidencia de múltiples factores en el desarrollo de estas lesiones, los resultados sugieren un mayor grado de estrés mecánico sobre la columna vertebral en los individuos masculinos y de los sectores más pobres de la Mendoza colonial.Schmorl’s nodes (NS) are lesions that affect the spine. Although their etiology is diverse, they have been interpreted as an injury possibly associated with physical activity. In this paper we analyze the prevalence of NS in 52 adult skeletons from the Área Fundacional in Mendoza from the seventeenth to nineteenth century. Its prevalence is discussed in combination with the development of marginal osteophytosis according to sex, age, socio-economic sectors, and chronological periods. A total prevalence of 21.1% was recorded. Although the incidence of multiple factors leading to the development of these lesions cannot be ruled out, the results suggest a greater degree of mechanical stress on the spine in male individuals and the poorer sectors of colonial MendozaFil: Mansegosa, Daniela A.. CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas) - Universidad Nacional de CuyoFil: Giannotti, Pablo S.. CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas) - Universidad Nacional de Cuy

Extra dimensions, orthopositronium decay, and stellar cooling

In a class of extra dimensional models with a warped metric and a single brane the photon can be localized on the brane by gravity only. An intriguing feature of these models is the possibility of the photon escaping into the extra dimensions. The search for this effect has motivated the present round of precision orthopositronium decay experiments. We point out that in this framework a photon in plasma should be metastable. We consider the astrophysical consequences of this observation, in particular, what it implies for the plasmon decay rate in globular cluster stars and for the core-collapse supernova cooling rate. The resulting bounds on the model parameter exceed the possible reach of orthopositronium experiments by many orders of magnitude.Comment: 13 pages, no figure

LIMB BODY WALL COMPLEX IN TWO HETEROZYGOTIC TWINS: A CASE REPORT

Introdution. Limb-Body Wall Complex (LBWC) is a congenital defect which includes at least two of the following characteristics: abdominal and/or thoracic body wall defects, exencephaly or encephalocoele with or without craniofacial defects (56%) and spinal defects associated with marked vertebral or sacral defects (95%). Case Report. We present a case report of an infant with LBWC, borned by diamniotic twin pregnancy. A prenatal ultrasound reported an healthy fetus and a fetus with multiple malformations. At birth we found a big abdominal wall defect, absence of scrotal sac and testicles, asymmetric chest and no major deformities in craniofacial region. At 2 hours of life, we removed the amniotic sac, we put the stomach and the spleen in the abdominal cavity, which is virtual, and positioned a spring-loaded silo. At 15th day of life we had complete reduction of the intestinal loops and liver and we closed the wall defect with a prosthesis and a cryopreserved skin. The general conditions of the patient, very severe since birth, became progressively worse and he died in the 21st day of life. Discussion. Once the diagnosis is done the physician should offer the parents a therapeutic abortion, and above all, in case they want to carry the pregnancy to term, we need to prepare them to the severity of the malformation and the high probability of death

Medication management ability in older patients: Time for a reappraisal

Background. Adhering to drug regimens is a complex and multidimensional task. Elderly patients usually take an average of seven drugs but most fail to adhere to the prescribed regimen. Several performance-based instruments have been developed to assess a patient\u2019s capacity to manage drugs but with inconsistent results. Aims. The aim of the study was to assess the prevalence of impaired medical management capacity in a sample of the oldest old hospitalized elderly patients and the main clinical factors associated with potential unintentional non-adherence. Methods. Forty-six consecutive patients were enrolled in the geriatric transitional care unit of Ospedale Policlinico San Martino, Genoa, Italy. All patients received an abbreviated comprehensive geriatric assessment and a hand grip assessment for sarcopenia. Patients\u2019 medication management ability was assessed by administering the DRUGS tool 48-74 hours before hospital discharge. Results. The results showed a negative correlation between age and total medication management score. A positive correlation was detected between functional status, cognitive status, and medication management score. Hand grip strength < 9 kg correlated with a significant worsening of medical management capacity. In contrast, multiple morbidities and the mean number of drugs were not associated with the medical management score. Conclusions. This preliminary study indicated that drug management capacity mainly relies on frailty markers, such as functional status, sarcopenia, and cognitive performance. Further studies are warranted to identify a subset of medical parameters that can accurately predict impaired medical management ability early, particularly for highly vulnerable elderly patients

Thermal-Hydraulic Analysis of Coolant Flow Decrease in Fuel Channels of Smolensk-3 RBMK during GDH Blockage Event

One of the transients that have received considerable attention in the safety evaluation of RBMK reactors is the partial break of a group distribution header (GDH). The coolant flow rate blockage in one GDH might lead to excessive heat-up of the pressure tubes and can result in multiple fuel channels (FC) ruptures. In this work, the GDH flow blockage transient has been studied considering the Smolensk-3 RBMK NPP (nuclear power plant). In the RBMK, each GDH distributes coolant to 40–43 FC. To investigate the behavior of each FC belonging to the damaged GDH and to have a more realistic trend, one (affected) GDH has been schematized with its forty-two FC, one by one. The calculations were performed using the 0-D NK (neutron kinetic) model of the RELAP5-3.3 stand-alone code. The results show that, during the event, the mass flow rate is disturbed differently according to the power distribution established for each FC in the schematization. The start time of the oscillations in mass flow rate depends strongly on the attributed power to each FC. It was also observed that, during the event, the fuel channels at higher thermal power values tend to undergo first cladding rupture leaving the reactor to scram and safeguarding all the other FCs connected to the affected GDH