Summative assessment of clinical practice of student nurses : a review of the literature

Objectives: To describe assessment of nursing student’s clinical practice concerned nursing education. Design: Systematic review and synthesis of qualitative and quantitative studies. Data sources: The data were collected with the support of an information specialist from scientific databases Cinahl, PubMed, Medic, ISI Web of Science, Cochrane library and Eric published in January 2000 – May 2014. All of the included studies citations were also performed. Methods: 725 articles concerned with nurse student clinical practice assessment were identified. After inclusion and exclusion criteria were met 23 articles for selected for critical review. Two independent reviewers selected the studies according to the inclusion criteria. These articles were analyzed using content analysis. Results: Findings suggest that the assessment process of nursing students’ clinical practice lacks consistency, it is open to the subjective bias of the assessor and the quality of assessment varies greatly. Nursing students clinical assessment was divided into 3 themes: acts (things to do) before final assessment, the actual final assessment situation and the acts after the final assessment situation. Mentors and students need orientation to the assessment process and to the paperwork by teachers. Terminology on evaluation forms is sometimes so difficult to grasp, that the mentors did not understand what they mean. There is no consensus about written assignments’ ability to describe the students’ skills. Mentors have timing problems to ensure relevant assessment of student nurses. At the final interview students normally self assess their performance, the mentor assesses by interview and by written assignments whether the student has achieved the criteria and role of the teacher is to support the mentor and the student in appropriate assessment. The variety of patient treatment environments in which nursing students do their clinical practice periods is challenging also for the assessment of nursing students’ expertise. Mentors alone want that clinical practice is a positive experience and it might lead to higher grades than what nurse student competency earns. It is very rare that students fail their clinical practice, if the student does not achieve the clinical competencies they are allowed to have extra time in clinical areas until they will be assessed as competent. Conclusions: This systematic review provides a description of challenges in nursing students’ assessment in clinical settings. Further research needs to be carried out to have more knowledge of final assessment in the end of the clinical practice. Through further research it will be possible to have better methods for high quality assessment processes and feedback to nurse students. Quality in assessment provides better nurses and therefore better patient safety

Port connectivity indices:an application to European RoRo shipping

In recent years, there has been significant interest in the development of connectivity indicators for ports. For short sea shipping, especially in Europe, Roll-on Roll-off (RoRo) shipping is almost equally important as container shipping. In contrast with container shipping, RoRo shipments are primarily direct, thus the measurement of its connectivity requires a different methodology. In this paper, we present a methodology for measuring the RoRo connectivity of ports and illustrate its use through an application to European RoRo shipping. We apply the methodology on data collected from 23 different RoRo shipping service providers concerning 620 unique routes connecting 148 ports. We characterize the connectivity of the ports in our sample and analyze the results. We show that in terms of RoRo connectivity, neither the number of links nor the link quality (frequency, number of competing providers, minimum number of indirect stops) strictly dominate the results of our proposed indicator. The highest ranking ports combine link quality and number. Finally, we highlight promising areas for future research based on the insights obtained

Outcome after Hybrid Outflow Interventions for Chronic Limb-threatening Ischemia

Background and Aims: Because chronic limb-threatening ischemia (CLTI) is often associated with multilevel arterial disease, it usually requires revascularization at different sites of the limb vasculature. We aim to assess the outcome of the hybrid interventions including open surgical revascularization together with outflow segment percutaneous transluminal angioplasty (PTA) in patients with chronic limb-threatening ischemia. Material and Methods: This study included all hybrid outflow-PTA interventions (n = 80) on patients suffering from CLTI performed in Helsinki University Hospital between 2003 and 2015. Follow-up ended on 31 December 2019. Patient data were prospectively collected into our vascular registry and scrutinized retrospectively. Thirty-one patients (39%) suffered from rest pain (Rutherford category IV) and 49 patients (61%) had ischemic ulcers (Rutherford category V-VI). The most common open surgical procedure was femoral endarterectomy (n = 63, 79%) and the most common endovascular procedure was superficial femoral artery percutaneous transluminal angioplasty (n = 65, 81%). Mean follow-up time was 56 months (range: 4 days-183 months). Results: Limb salvage was at 30 days-92%, at 1 year-91%, and at 5 and 10 years-86%. Survival and amputation-free survival were at 30 days-93% and 86%, at 1 year-80% and 76%, at 5 years-51% and 48%, and at 10 years-21% and 21%. Wound healing at 3, 6, and 12 months was 48%, 71%, and 87%. Freedom from target lesion revascularization was at 30 days-97%, at 1 year-88%, at 5 years-72%, and at 10 years-66%. Conclusion: Hybrid outflow revascularization is an important tool in the vascular surgeon's armamentarium for treatment of patients with multilevel arterial disease causing chronic limb-threatening ischemia.Peer reviewe

A New Application of the Gursey and Radicati Mass Formula

We study the spin- and flavour- dependent SU(6) violations in the baryon spectrum by means of a G\"ursey Radicati mass formula. The average energy of each SU(6)-multiplet is described using the SU(6) invariant interaction given by a hypercentral potential containing a linear and a hypercoulomb term. We show that the non strange and strange baryon masses are in general fairly well reproduced and moreover that the G\"ursey Radicati formula holds in a satisfactory way also for the excited states up to 2 GeV. The coefficients of the G\"ursey Radicati SU(6) breaking part obtained by the fit of the three-quark spectrum can be used to evaluate in first approximation the splitting within multiplets also for exotic baryon systems.Comment: 9 pages, 2 figures, 2 table, submitted to Eur. Phys. J.

Spectroscopy of pentaquark states

We construct a complete classification of pentaquark states in terms of the spin-flavour SU(6) representations. We find that only some definite SU(3) representations are allowed, singlets, octets, decuplets, anti-decuplets, 27-plets and 35-plets. The latter three contain exotic states, which cannot be constructed from three quarks only. This complete classification scheme is general and model independent and is useful both for model builders and experimentalists. The mass spectrum is obtained from a Gursey-Radicati type mass formula, whose coefficients have been determined previously by a study of qqq baryons. The ground state pentaquark which is identified with the recently observed Theta(1540) state, is predicted to be an isosinglet anti-decuplet state. Its parity depends on the interplay between the spin-flavour and orbital contributions to the mass operator.Comment: 26 pages, 4 figures, 11 tables, revised version with 2 extra tables, an updated list of references and expanded discussion of the results. Accepted for publication in Eur. Phys. J.

Greater Success of Primary Fascial Closure of the Open Abdomen : A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

Background and Aims: The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Material and Methods: Open abdomen patients (n=61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Results and Conclusion: Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p=0.039) and the highest fascial repair rate (p=0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.Peer reviewe

Use of oral health care services in Finnish adults - results from the cross-sectional Health 2000 and 2011 Surveys

Background: During the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011. Methods: The data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged >= 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen's model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation. Results: No major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector. Conclusions: Overall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care.Peer reviewe

Electromechanical film sensor device for dynamic force recordings from canine limbs

An equipment based on the electromechanical film (EMF) sensors was designed for the measurementof forces acting upon canine limbs. EMF forms an elastic electret, which generates on its surface an electric charge proportional to the the force applied on it. The EMF sensors were calibrated using a conventional material testing device with cyclic loads. The beagles were trained on a treadmill working at horizontal position or with either 15° uphill or downhill inclination. The treadmill belt speed varied from 2.5 km/h to 7.5 km/h. The force under the canine paws varied depending on the inclination of the treadmill. When the dogs ran uphill, weight-bearing on hind1imbs increased 11% but the weight-bearing 0n forelimbs did not change. Downhill running increased weight-bearing on forelimbs by 8% and decreased weight-bcaring of the hindlimbs by 5%. Immobilization of the right hind] imb increased weightbearing on both forelimbs by 7-25% and on the left hindlimb by 56%. One month after a 30° valgus osteotomy operation at the right tibia, the dynamic force recorded From the operated hindlimb was 69% of the control value. Three months after osteotomy, the weight-bearing of the operated limb approachednormal situation. Our results suggest that the EMF sensor is a reliable method for the measurement of dynamic forces acting on the weight-bearing limbs of the dogs