STUDENT ENGAGEMENT IN NURSING SCHOOL: A SECONDARY ANALYSIS OF THE NATIONAL SURVEY OF STUDENT ENGAGEMENT DATA

Student engagement has received considerable attention in higher education research because of the link between increased student knowledge, greater student satisfaction with educational experience, and increased student retention and persistence. The National Survey of Student Engagement (NSSE) has been used since 2000 to assess engagement in undergraduate college students. NSSE results have been used to gain an understanding about levels of academic engagement for freshman and senior college students. Institutions use NSSE results to make changes in policies and practices to improve undergraduate education. This comparative descriptive study examined levels of undergraduate nursing students’ engagement during college by conducting a secondary analysis of NSSE data. The overall aim of this study was to gain a better understanding of nursing students’ levels of engagement at two points in time and comparing two geographic regions, and how they spent their time while in college. In a 2007 report, the National Leadership Council for Liberal Education and America’s Promise (LEAP) identified ten innovative high-impact practices in higher education. Since then, these practices have been implemented across the nation and have been associated with gains in student learning and personal development (Kuh, 2008). This study compared senior nursing students’ levels of engagement before and after these high-impact practices were recommended to see if engagement levels in senior nursing students differed between 2003 and 2010. Astin’s student involvement theory was used as a guiding framework for this study to examine how nursing students engage in the learning process and what educational resources nursing students use to become involved in the learning process. Astin’s theory focuses on what the college student does to be an active participant in the learning process and describes the environmental influences on college student development. Although statistically significant, the differences between the 2003 and 2010 nationwide cohorts of nursing students for the Level of Academic Challenge and Student-Faculty Interaction benchmarks were trivial. Senior nursing students were equally as engaged in 2010 as they were in 2003. This finding suggests consistency and stability in nursing education with regard to the Level of Academic Challenge and Student-Faculty Interaction benchmarks. Senior nursing students from Kansas and Missouri were compared to senior nursing students from all other states. Senior nursing students from KS/MO were similar to students from all other states in relation to Level of Academic Challenge and Active and Collaborative Learning benchmarks and how they spent their time in a typical 7-day week. Although statistically significant, the difference between the KS/MO cohort of nursing students and cohort of nursing students from other states for the Student-Faculty Interaction benchmark was trivial. In general, senior nursing students in 2010 were as engaged in their education as they were in 2003, reflecting stability in nursing education during this same time period. Senior nursing students from KS/MO were as engaged and spent their time in a similar manner as senior nursing students from all other states. This indicates that nursing students from these Midwest states have similar educational engagement as nursing students from other states and nursing education in the Midwest is consistent with the rest of the country. These findings of stability and consistency over time and across regions of the US are encouraging for nursing education. Nurse educators and higher-education administrators can build upon this strong foundation and make concerted efforts to further increase engagement in nursing students

Vinorelbine plus platinum compared to vinorelbine plus capecitabine in treatment of patients with metastatic triple negative breast cancer previously treated with anthracycline and taxane: a prospective randomized study

Introduction. This study aims to investigate the efficacy and tolerability of the vinorelbine-based combination chemotherapy with either cisplatin or capecitabine in metastatic triple-negative breast cancer (mTNBC) pretreated with anthracycline and taxane.  Material and methods. This is an open-labeled randomized prospective single-institute study, that included all patients who received chemotherapy for mTNBC in the period between 1st of July 2016 and 30th of June 2017 and were pretreated with anthracycline and taxane. Patients were randomized to either vinorelbine 25 mg/m2 I.V on days 1 and 8 plus oral capecitabine 1000 mg/m2 twice daily, on days 1–14 (NX); or vinorelbine 25 mg/m2 I.V on days 1 and 8 plus cisplatin 75 mg/m2 (NP), every 21 days. The primary endpoint was time to progression (TTP), whereas the secondary endpoints were objective response rate (ORR), safety, and overall survival (OS).  Results. Median TTP was 9.9 months with NP vs. 8 months with NX, (p = 0.22). ORR was 40% with NP vs. 36% with NX, (p = 0.77). Median OS was 13 months with NP vs. 13.2 months with NX (p = 0.599). Both regimens demonstrated similar rates of grade ≥ 3 vomiting and neutropenia. A higher incidence of thrombocytopenia, tinnitus, and kidney function alteration were reported with NP. A higher incidence of anorexia, diarrhea, mucositis, and hand-foot syndrome were reported with NX.  Conclusions. Vinorelbine-based combination chemotherapy regimens with either cisplatin or capecitabine are active in the treatment of mTNBC pretreated with anthracycline and taxane with manageable toxicity profiles. Both regimens have comparable TTP, ORR, OS, and safety profiles

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)