Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in Medical Intensive Care Unit

Context: The Glasgow Coma Scale (GCS) is the most commonly used scale, and Full Outline of Unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS in the evaluation of the level of consciousness. Aim: The aim of the current study was to evaluate FOUR score and GCS ability in predicting the outcomes (Survivors, nonsurvivors) in Medical Intensive Care Unit (MICU). Setting and Design: This was an observational and prospective study of 300 consecutive patients admitted to the MICU during a 14 months' period. Materials and Methods: FOUR score, GCS score, and demographic characteristics of all patients were recorded in the first admission 24 h. Statistical Analysis Used: A receiver operator characteristic (ROC) curve, Hosmer–Lemeshow test, and Logistic regression were used in the statistical analysis (95% confidence interval). Results: Data analysis showed a significant statistical difference in FOUR score and GCS score between survivors and nonsurvivors (P < 0.0001, P < 0.0001; respectively). The discrimination power was good for both FOUR score and GCS (area under ROC curve: 87.3% (standard error [SE]: 2.1%), 82.6% [SE: 2.3%]; respectively). The acceptable calibration was seen just for FOUR score (χ2 = 8.059, P = 0.428). Conclusions: Both FOUR score and GCS are valuable scales for predicting outcomes in patients are admitted to the MICU; however, the FOUR score showed better discrimination and calibration than GCS, so it is superior to GCS in predicting outcomes in this patients population

Comparison of acute physiology and chronic health evaluation II and Glasgow Coma Score in predicting the outcomes of Post Anesthesia Care Unit′s patients

Context: Acute physiology and chronic health evaluation II (APACHE II) is one of the most general classification systems of disease severity in Intensive Care Units and Glasgow Coma Score (GCS) is one of the most specific ones. Aims: The aim of the current study was to assess APACHE II and GCS ability in predicting the outcomes (survivors, non-survivors) in the Post Anesthesia Care Unit′s (PACU). Settings and Design: This was an observational and prospective study of 150 consecutive patients admitted in the PACU during 6-month period. Materials and Methods: Demographic information recorded on a checklist, also information about severity of disease calculated based on APACHE II scoring system in the first admission 24 h and GCS scale. Statistical Analysis Used: Logistic regression, Hosmer-Lemeshow test and receiver operator characteristic (ROC) curves were used in statistical analysis (95% confidence interval). Results: Data analysis showed a significant statistical difference between outcomes and both APACHE II and Glasgow Coma Score (GCS) (P < 0.0001). The ROC-curve analysis suggested that the predictive ability of GCS is slightly better than APACHE II in this study. For GCS the area under the ROC curve was 86.1% (standard error [SE]: 3.8%), and for APACHE II it was 85.7% (SE: 3.5%), also the Hosmer-Lemeshow statistic revealed better calibration for GCS (χ2 = 5.177, P = 0.521), than APACHE II (χ2 = 10.203, P = 0.251). Conclusions: The survivors had significantly lower APACHE II and higher GCS compared with non-survivors, also GCS showed more predictive accuracy than APACHE II in prognosticating the outcomes in PACU

Comparing the Effects of Lecture, E-Learning and Concept Mapping on Pediatrics Nursing Teaching

Introduction: Meaningful learning is an important factor in promoting creative thinking, critical thinking and problem-solving abilities in learners. Thus, the purpose of this study was to compare the effects of pediatric nursing teaching in the forms of lecture, e-learning and concept mapping on the cognitive levels of recalling, comprehension and application. Methods: This research was a quasi-experimental study with a three-group, pre-test post-test design. Sixty-four 5th-semester nursing students were selected through census method and randomly divided into experimental and control groups. For the third group, half of the students from both classes, who were familiar with and had access to internet, were selected randomly and purposively. After the pre-test, the control, experimental and e-learning groups received training using lecture, concept mapping and e-learning methods respectively for four sessions over a one-month period. Then, the post-test was taken and four weeks after that, the recall test was performed. Data were collected using a research-made academic achievement test. The results were analyzed using ANOVA, chi-square, independent and paired t-tests. Results: All three methods of lecture (t=-2.41, p=0.02), e-learning (t=-1.45, p=0.17) and concept mapping (t=-2.19, p=0.04) were effective in enhancing students’ knowledge and learning. However, meaningful learning and the mean scores of pre- and post-tests were statistically significant only for the concept mapping method (15.16±1.37, 17.44±1. 58, t=-5.45, p<0.001). Conclusion: Since the concept mapping method was more effective than the other two methods in students’ achieving higher levels of learning and meaningful learning, it is suggested that this method should be employed more in nursing education