Metacognitive awareness : impact of a metacognitive intervention in a pre-nursing course

To function effectively as nurses in the evolving, complex healthcare system, nursing students must learn to be skilled thinkers, know how to learn, and know how to use what they know in novel situations. Research in the field of metacognition may offer a useful framework to improve learning and to enhance critical thinking and clinical decision-making in nursing students. The purpose of this study is to describe how pre-nursing students’ self-reported metacognitive awareness correlates with age and academic variables and to explore the effects of a metacognitive intervention on students’ metacognitive awareness. Using a quasi-experimental research design, the study consisted of a pre-test, an intervention, and a post-test with no control group. Students in a pre-nursing course completed the Metacognitive Awareness Inventory (MAI) before and after a metacognitive intervention. Students’ pre-test scores on the MAI were correlated to age and academic indicators including overall College grade point average (GPA), nursing GPA, and standardized test scores on the Test of Essential Academic Skills (TEAS). Post-test MAI scores were correlated with grades on the final reflective portfolio, a course-specific academic indicator. The study also analyzed whether or not there was a statistically significant increase in MAI scores following a metacognitive intervention. Results of the study indicated that, in adult pre-nursing students, metacognitive awareness is not correlated with age or academic indicators. Following the metacognitive intervention, there was a statistically significant increase in students’ knowledge of cognition. Increases in total MAI scores and regulation of cognition scores were not statistically significant. Recommendations for improvements in faculty development related to metacognition and metacognitive interventions and implications for future research are discussed

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons