Using Ignatian Pedagogy to Improve Reflective Thinking in Neonatal Nurse Practitioner Students

This project reports the outcomes of development of a tool for teaching reflective thinking in the neonatal nurse practitioner (NNP) student. The purpose of this project was to improve patient care by preparing a mindful, reflective NNP. The project premise was encouraging reflection would enhance what students understand about aspects of patient care, to include all phases of healthcare processes: assessment, diagnosis, planning, intervention, and evaluation. The Ignatian Pedagogy Conceptual Model© was utilized as a teaching tool to create reflective thinking assignments for NNP students in their final clinical practicum. Significance of the project was to examine whether the tool demonstrated improved reflective thinking, as assessed on Kember\u27s Reflective Thinking Questionnaire. In this study, the typical participant was female, aged 31-35 years with 6-10 years of NICU experience. The small sample size in this study was unable to duplicate previous study findings of improvement in reflective thinking. The project succeeded in developing and testing an educational strategy to advance learning. The teaching tool provided structure for student reflection and supported a transition from exclusive passive learning to participative, active learning. Assessing, encouraging, and teaching reflective thinking through practice may ultimately demonstrate improvement in patient care

Portfolio pointers: Preparing and presenting high quality teaching portfolios

This goal of this project was to develop a set of guidelines for creating teaching portfolios for the Tertiary Teaching Excellence Awards or for other purposes. It includes key pointers to “getting started”, collecting evidence, interrogating practice, editing, and protecting the unique “voice” of the nominee and their student body. The guidelines consist of general principles and practical examples from both successful academic developers and award recipients and some examples from award-winning portfolios to illustrate good practice

Signposts: Resource for staff developers

This guide is for staff developers who work with new tertiary teachers, and provides guidelines on how to use 'Signposts: A professional development resource for new teaching staff in the tertiary sector'. It is the result of a project funded by the Ako Aotearoa Northern Hub

Contemporary hormone therapy with LHRH agonists for prostate cancer: avoiding osteoporosis and fracture.

© 2015 Polish Urological Association. All Rights Reserved.Introduction Prostate cancer is a large clinical burden across Europe. It is, in fact, the most common cancer in males, accounting for more than 92,300 deaths annually throughout the continent. Prostate cancer is androgen-sensitive; thus an androgen deprivation therapy (ADT) is often used for treatment by reducing androgen to castrate levels. Several ADT agents have achieved benefits with effective palliation, but, unfortunately, severe adverse events are frequent. Contemporary ADT (Luteinising Hormone Releasing Hormone agonist - LHRHa injections) can result in side effects that include osteoporosis and fractures, compromising quality of life and survival.  Methods In this review we analysed the associated bone toxicity consequent upon contemporary ADT and based on the literature and our own experience we present future perspectives that seek to mitigate this associated toxicity both by development of novel therapies and by better identification and prediction of fracture risk. Results Preliminary results indicate that parenteral oestrogen can mitigate associated osteoporotic risk and that CT scans could provide a more accurate indicator of overall bone quality and hence fracture risk.  Conclusions As healthcare costs increase globally, cheap and effective alternatives that achieve ADT, but mitigate or avoid such bone toxicities, will be needed. More so, innovative techniques to improve both the measurement and the extent of this toxicity, by assessing bone health and prediction of fracture risk, are also required

Increasing Thiamine Concentrations in Lake Trout Eggs from Lakes Huron and Michigan Coincide with Low Alewife Abundance

Lake trout Salvelinus namaycush in the Laurentian Great Lakes suffer from thiamine deficiency as a result of adult lake trout consuming prey containing thiaminase, a thiamine-degrading enzyme. Sufficiently low egg thiamine concentrations result in direct mortality of or sublethal effects on newly hatched lake trout fry. To determine the prevalence and severity of low thiamine in lake trout eggs, we monitored thiamine concentrations in lake trout eggs from 15 sites in Lakes Huron and Michigan from 2001 to 2009. Lake trout egg thiamine concentrations at most sites in both lakes were initially low and increased over time at 11 of 15 sites, and the proportion of females with egg thiamine concentrations lower than the recommended management objective of 4 nmol/g decreased over time at eight sites. Egg thiamine concentrations at five of six sites in Lakes Huron and Michigan were significantly inversely related to site-specific estimates of mean abundance of alewives Alosa pseudoharengus, and successful natural reproduction of lake trout has been observed in Lake Huron since the alewife population crashed. These results support the hypothesis that low egg thiamine in Great Lakes lake trout is associated with increased alewife abundance and that low alewife abundance may currently be a prerequisite for successful reproduction by lake trout in the Great Lakes

Evaluating the Effect of Stressors on Thiaminase Activity in Alewife

Abstract.-No consistent explanation has been found for the variability in the thiaminase activity of alewives Alosa pseudoharengus despite the role of alewife thiaminase in large-scale salmonine mortality in the Laurentian Great Lakes. We conducted experiments to evaluate the effect of two stressors, reduced salt content in the water and food limitation, on alewife thiaminase activity. Alewives were subjected to treatments in replicated tanks in which conductivity was lowered (,100 lS/cm) for 8 d and feeding was limited for 39 d. Circulating white blood cells, plasma cortisol, plasma glucose, and whole-body thiaminase were measured in individual alewives to assess their response to these experimental treatments. Alewives from the controls had significantly larger numbers of circulating white blood cells than those in the salt-reduced and food-limite

Periconceptional Undernutrition in Sheep Affects Adult Phenotype Only in Males

Periconceptional undernutrition (PCUN) in sheep alters fetal growth and metabolism and postnatal growth regulation, but effects on adult body composition are unknown. We investigated the effects of PCUN on adult phenotype. Singleton lambs of ewes fed normally (N, n=17) or undernourished before (UN-61-0 d, n=23), before and after (UN-61-30 d, n=19), or after (UN-2-30d, n=17) mating (d0) were weighed at birth, 12 weeks, and intermittently to adulthood. At the age of 3-4 years, body composition was assessed by dual-emission X-ray absorptiometry followed by postmortem examination. Compared with N animals, male, but not female, offspring of all UN groups had greater % fat mass (all UN versus N: 9±1 versus 2±1%, P<0.001) and perirenal fat (544±36 versus 222±44 g, P=0.002), and proportionately smaller hearts (4.5±0.1 versus 5.2±0.2 g·kg−1), lungs (9.1±0.2 versus 10.6±0.5 g·kg−1), and adrenals (0.06±0.002 versus 0.08±0.003 g·kg−1). UN males also had larger testes (726±21 versus 545±32 g, P=0.007), but UN females had smaller ovaries (2.7±0.08 versus 3.4±0.4 g, P=0.01). Changes were independent of birth weight or postnatal growth velocity. Brief PCUN has sex-specific effects on adult phenotype, predominantly affecting males, which may contribute to adverse metabolic outcomes

A randomised comparison evaluating changes in bone mineral density in advanced prostate cancer: luteinising hormone-releasing hormone agonists versus transdermal oestradiol.

BACKGROUND: Luteinising hormone-releasing hormone agonists (LHRHa), used as androgen deprivation therapy (ADT) in prostate cancer (PCa) management, reduce serum oestradiol as well as testosterone, causing bone mineral density (BMD) loss. Transdermal oestradiol is a potential alternative to LHRHa. OBJECTIVE: To compare BMD change in men receiving either LHRHa or oestradiol patches (OP). DESIGN, SETTING, AND PARTICIPANTS: Men with locally advanced or metastatic PCa participating in the randomised UK Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) trial (allocation ratio of 1:2 for LHRHa:OP, 2006-2011; 1:1, thereafter) were recruited into a BMD study (2006-2012). Dual-energy x-ray absorptiometry scans were performed at baseline, 1 yr, and 2 yr. INTERVENTIONS: LHRHa as per local practice, OP (FemSeven 100μg/24h patches). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was 1-yr change in lumbar spine (LS) BMD from baseline compared between randomised arms using analysis of covariance. RESULTS AND LIMITATIONS: A total of 74 eligible men (LHRHa 28, OP 46) participated from seven centres. Baseline clinical characteristics and 3-mo castration rates (testosterone ≤1.7 nmol/l, LHRHa 96% [26 of 27], OP 96% [43 of 45]) were similar between arms. Mean 1-yr change in LS BMD was -0.021g/cm(3) for patients randomised to the LHRHa arm (mean percentage change -1.4%) and +0.069g/cm(3) for the OP arm (+6.0%; p<0.001). Similar patterns were seen in hip and total body measurements. The largest difference between arms was at 2 yr for those remaining on allocated treatment only: LS BMD mean percentage change LHRHa -3.0% and OP +7.9% (p<0.001). CONCLUSIONS: Transdermal oestradiol as a single agent produces castration levels of testosterone while mitigating BMD loss. These early data provide further supporting evidence for the ongoing phase 3 trial. PATIENT SUMMARY: This study found that prostate cancer patients treated with transdermal oestradiol for hormonal therapy did not experience the loss in bone mineral density seen with luteinising hormone-releasing hormone agonists. Other clinical outcomes for this treatment approach are being evaluated in the ongoing PATCH trial. TRIAL REGISTRATION: ISRCTN70406718, PATCH trial (ClinicalTrials.gov NCT00303784)

A randomised comparison evaluating changes in bone mineral density in advanced prostate cancer: luteinising hormone-releasing hormone agonists versus transdermal oestradiol

Background Luteinising hormone-releasing hormone agonists (LHRHa), used as androgen deprivation therapy (ADT) in prostate cancer (PCa) management, reduce serum oestradiol as well as testosterone, causing bone mineral density (BMD) loss. Transdermal oestradiol is a potential alternative to LHRHa. Objective To compare BMD change in men receiving either LHRHa or oestradiol patches (OP). Design, setting, and participants Men with locally advanced or metastatic PCa participating in the randomised UK Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) trial (allocation ratio of 1:2 for LHRHa:OP, 2006–2011; 1:1, thereafter) were recruited into a BMD study (2006–2012). Dual-energy x-ray absorptiometry scans were performed at baseline, 1 yr, and 2 yr. Interventions LHRHa as per local practice, OP (FemSeven 100 μg/24 h patches). Outcome measurements and statistical analysis The primary outcome was 1-yr change in lumbar spine (LS) BMD from baseline compared between randomised arms using analysis of covariance. Results and limitations A total of 74 eligible men (LHRHa 28, OP 46) participated from seven centres. Baseline clinical characteristics and 3-mo castration rates (testosterone ≤1.7 nmol/l, LHRHa 96% [26 of 27], OP 96% [43 of 45]) were similar between arms. Mean 1-yr change in LS BMD was −0.021 g/cm3 for patients randomised to the LHRHa arm (mean percentage change −1.4%) and +0.069 g/cm3 for the OP arm (+6.0%; p < 0.001). Similar patterns were seen in hip and total body measurements. The largest difference between arms was at 2 yr for those remaining on allocated treatment only: LS BMD mean percentage change LHRHa −3.0% and OP +7.9% (p < 0.001). Conclusions Transdermal oestradiol as a single agent produces castration levels of testosterone while mitigating BMD loss. These early data provide further supporting evidence for the ongoing phase 3 trial