Integration of Evidence-Based Practice in Nursing Education

Evidence based practice (EBP) has gained momentum globally, to provide effective and efficient health care. Although EBP has evolved to a great extent over the last two decades and is accepted as an important concept by all health care professionals, its integration in practice is still challenging. Integration of EBP in nursing profession both in nursing practice and nursing education is an important issue. This article describes the experience of the authors in integrating evidence based practice in nursing education in Manipal University. It focuses on the training of nurse educators in EBP, alignment of EBP in curriculum and EBP practicum in curriculum so as to enable a nurse to identify evidences, make appropriate clinical decisions and utilize EBP in rendering scientific and quality patient care

Rubrics in Nursing Education

Evaluating assignments or course work is a challenging job for faculty of nursing. In order to avoid the dilemmas of evaluation, nurse educators use rubrics as an evaluation tool. In educational technology, rubric refers to „performance standard‟ for a student population. A rubric is defined as an assessment tool that lays out the set standards and criteria to assess a performance, assignment or behavior. The four essential components of a rubric are task description, scale of achievement, dimensions & description of dimensions. Various types of scoring rubrics are available. The type of rubric chosen for assessment depends on the task being evaluated and the needs of the assessor. Holistic rubrics, analytic rubrics, generic rubrics, specific rubrics are the different types of rubrics. In nursing education, rubrics has got wide range of applications such as to; assess clinical skills, grade assignments, evaluate clinical competency and analyze presentations. Rubrics helps to define "quality performance” and promote awareness on critical components in a performance. Rubrics not only act as an evaluation tool for instructors, but also act as a feedback proforma for students. Rubrics are vital tools that can be utilized to solve the problem of subjectivity in evaluation. Rubrics provide consistency in evaluation, reduces subjectivity and enhances objectivity

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews

BACKGROUND: To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS: Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION: Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings

Evaluation of carcinogenic/co-carcinogenic activity of a common chewing product, pan masala, in mouse skin, stomach and esophagus

Pan masala, a dry powdered mixture of areca nut, catechu, lime, unspecified spices and flavoring agents, has gained widespread popularity as a chewing substitute in India. In this study, the carcinogenic and tumor-promoting potential of an ethanolic pan masala extract (EPME) was determined using skin of S/RVCri-ba mice and forestomach and esophagus of ICRC mice as the target tissues. Carcinogenic activity of pan masala was tested by painting the mouse skin for 40 weeks with EPME or by gavage feeding for 6 months. Following initiation with 9,10-dimethylbenz(a)anthracene (DMBA), carcinogenesis of mouse skin was promoted with different doses of EPME, while gastric- and esophageal-tumor-promoting activity was determined by administering EPME by gavage to animals initiated with diethylnitrosamine (DEN). The ability of EPME to effect progression of skin papilloma to carcinoma and cutaneous alterations after a single or multiple EPME treatment were also evaluated. EPME at 25 mg per dose promoted skin-papilloma formation between 30 and 40 weeks of treatment and enhanced the rate of conversion of papilloma to carcinoma. Induction of mild epidermal hyperplasia, dermal edema, increase in epidermal mitotic activity and the rate of epidermal and dermal DNA synthesis by EPME correlated well with its skin-tumor-promoting potential. In ICRC mice, EPME was inactive as a complete carcinogen, but effectively promoted the development of forestomach and esophageal papilloma and carcinoma in a concentration-dependent manner. The tumor incidence at 25 mg EPME per dose was comparable with that obtained in the 12-0-tetradecanoylphorbol-13 acetate(TPA)-treated group. The findings indicate that habitual pan-masala use may exert carcinogenic and co-carcinogenic influence

The unusual UBZ domain of Saccharomyces cerevisiae polymerase η

Recent research has revealed the presence of ubiquitin-binding domains in the Y family polymerases. The ubiquitin-binding zinc finger (UBZ) domain of human polymerase η is vital for its regulation, localization, and function. Here, we elucidate structural and functional features of the non-canonical UBZ motif of Saccharomyces cerevisiae pol η. Characterization of pol η mutants confirms the importance of the UBZ motif and implies that its function is independent of zinc binding. Intriguingly, we demonstrate that zinc does bind to and affect the structure of the purified UBZ domain, but is not required for its ubiquitin-binding activity. Our finding that this unusual zinc finger is able to interact with ubiquitin even in its apo form adds support to the model that ubiquitin binding is the primary and functionally important activity of the UBZ domain in S. cerevisiae polymerase η. Putative ubiquitin-binding domains, primarily UBZs, are identified in the majority of known pol η homologs. We discuss the implications of our observations for zinc finger structure and pol η regulation.National Institute of Environmental Health Sciences (Grant ES-015818)National Institute of Environmental Health Sciences (Grant P30 ES-002109)American Cancer Society (Research Professorship

Resources for Evidence-Based Health Care: Accessibility and Availability

Evidence – Based Practice (EBP) is a problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well-designed studies, clinician’s expertise, and patient values and preferences (Melnyk & Fineout-Overholt, 2005; Sackett, Straus, Richardson, Rosenberg, &Haynes, 2000). It is important to see clinical expertise as the ability to integrate research evidence and patients' circumstances and preferences to help patients arrive at optimal decisions (Guyatt, Cook,& Haynes, 2004). Research has shown that patient outcomes are 28% better when clinical care is based upon evidence, versus clinical practice steeped in tradition (Heater, Becker, & Olsen, 1998). The process of EBP minimizes the translation time needed for incorporating research findings into practice and clarifies the differences between ritualistic practice, habitual approaches, personal preferences, anecdotal experiences, empirical data, and statistical significance to support nursing practice (Alspach, 2006). The availability of evidence based practice tools and methods helps in faster identification of the best available evidence to provide care at the point it matters most. Implementing EBP in health care is complex and challenging. One of the main components of EBP is retrieving evidence from different sources. Information explosion with thousands of health literature and research papers published every year has created a need to expand the knowledge base for providing evidence based health care worldwide. Retrieval of evidence from various sources may be difficult due to several reasons. It may be difficult for health professionals to find the best available evidence due to time constraints (Ervin, 2002) or lack of knowledge among health professionals to effectively search for evidence (Sitzia, 2002). It is even difficult to find authentic sources of evidence

Undertaking Systematic Reviews in Nursing

Health care knowledge is rapidly evolving with inexorable volumes of research based information geing published every day. Systematic reviews provide comprehensive and unbiased summaries of a research on a single topic. Systematic reviews are considered as the gold standard for summarizing evidence found in research literature. The objective of this article is to sensitize nurses regarding systematic reviews by summarizing major steps and process involved in doing a systematic review. Doing a systematic review requires significant planning and execution. This article is an introductory description on how to undertake a systematic review. A thorough understanding of systematic review is necessary to make a quality review. Following the systematic rigorous methodology helps to reduce bias and improve the reliability and accuracy of conclusions

Long-term carcinogenicity of pan masala in Swiss mice

Carcinogenicity of pan masala, a dry powdered chewing mixture of areca nut, catechu, lime, spices and flavoring agents was evaluated by means of the long-term animal bio-assay 6- to 7-week old male and female S/RVCri mice were divided randomly into intermediate and lifetime exposure groups and fed normal diet without pan masala - (zero dose) or diet containing 2.5% and 5% pan masala. Animals in the intermediate-exposure group (n = 10/gender/dose group) were killed after 6, 12 or 18 months of treatment, while those in the lifetime-exposure group (n = 54/gender/dose group) were killed when moribund or at the termination of the experiment at 24 months. Several tissues were processed for histopathological examination. The body weight and survival rate of mice fed pan masala were lower than that of the controls. Histopathological observations of tissues from control animals did not reveal any neoplastic alterations. However, lifetime feeding of pan masala induced adenoma of the liver, stomach, prostate and sebaceous glands, also forestomach papilloma, liver hamartoma, hepatoma and hemangioma, carcinoma of the forestomach, adenocarcinoma of the lung and liver, and testicular lymphoma. Neoplastic lesions appeared mainly in the liver (n = 13), stomach (n = 3) and lung (n = 8). Lung adenocarcinoma, the most frequent malignant tumor type, was observed in 2/120 mice in the intermediate-exposure group and in 8/216 animals in the lifetime-exposure group. Statistical analysis of tumor-induction data revealed a significant dose-related increase in lung adenocarcinomas but not in liver and stomach neoplasms indicating that lung is the major target tissue for the carcinogenic action of pan masala

The progenitors of the intra-cluster light and intra-cluster globular clusters in galaxy groups and clusters

We use the IllustrisTNG50 cosmological hydrodynamical simulation, complemented by a catalog of tagged globular clusters, to investigate the properties and build up of two extended luminous components: the intra-cluster light (ICL) and the intra-cluster globular clusters (ICGC). We select the 39 most massive groups and clusters in the box, spanning the range of virial masses $5 \times 10^{12} < \rm M_{200}/\rm M_{\odot} < 2 \times 10^{14}$. We find good agreement between predictions from the simulations and current observational estimates of the fraction of mass in the ICL and its radial extension. The stellar mass of the ICL is only $\sim10\%-20\%$ of the stellar mass in the central galaxy but encodes useful information on the assembly history of the group or cluster. About half the ICL in all our systems is brought in by galaxies in a narrow stellar mass range, $M_*=10^{10}-10^{11}$ $\rm M_{\odot}$. However, the contribution of low-mass galaxies ($M_*<10^{10}$ $\rm M_{\odot}$) to the build-up of the ICL varies broadly from system to system, $\sim 5\%-45\%$, a feature that might be recovered from the observable properties of the ICL at $z=0$. At fixed virial mass, systems where the accretion of dwarf galaxies plays an important role have shallower metallicity profiles, less metal content and a lower stellar mass in the ICL than systems where the main contributors are more massive galaxies. We show that intra-cluster GCs are also good tracers of this history, representing a valuable alternative when diffuse light is not detectable

Double Exponential Instability of Triangular Arbitrage Systems

If financial markets displayed the informational efficiency postulated in the efficient markets hypothesis (EMH), arbitrage operations would be self-extinguishing. The present paper considers arbitrage sequences in foreign exchange (FX) markets, in which trading platforms and information are fragmented. In Kozyakin et al. (2010) and Cross et al. (2012) it was shown that sequences of triangular arbitrage operations in FX markets containing 4 currencies and trader-arbitrageurs tend to display periodicity or grow exponentially rather than being self-extinguishing. This paper extends the analysis to 5 or higher-order currency worlds. The key findings are that in a 5-currency world arbitrage sequences may also follow an exponential law as well as display periodicity, but that in higher-order currency worlds a double exponential law may additionally apply. There is an "inheritance of instability" in the higher-order currency worlds. Profitable arbitrage operations are thus endemic rather that displaying the self-extinguishing properties implied by the EMH.Comment: 22 pages, 22 bibliography references, expanded Introduction and Conclusion, added bibliohraphy reference