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PubMed1999

The effects of computer-assisted instruction on the self-efficacy of baccalaureate nursing students.

As computer-assisted instruction (CAI) use has increased during the past few years, nurse educators have expressed concern regarding its effectiveness. The purpose of this quasiexperimental study was to determine if completion of a computerized simulation about a surgical patient increased baccalaureate nursing students' self-efficacy about caring for surgical patients in the clinical environment. Such an association is desirable because increased levels of self-efficacy have been associated with increased motivation, goal-setting, and achievement. A nonprobability, convenience sample (N = 23) of second-year baccalaureate nursing students was assigned randomly to experimental and control groups. The self-efficacy of the experimental group was measured three times: on an initial pretest; following the intervention of a computer simulation; and after an 8-week clinical rotation. The self-efficacy of the control group was measured on an initial pretest and after the 8-week rotation. Higher preclinical self-efficacy scores (p<.01) of the experimental group support the use of CAI as an important aspect of clinical education. Implications for nursing education, practice, and research are addressed. Computer-assisted instruction (CAI) has been available for several decades; however, its use in nursing education has escalated during the past few years. This intensified interest is the result of a decrease in the cost of computer hardware and an increase in the availability of relevant educational software (Wright, 1995). Cutbacks to educational funding, along with the rising costs of clinical teaching, have motivated studies of this method of nursing education. The purpose of this pilot study was to determine if completion of a supplemental computerized simulation about a surgical patient increased baccalaureate nursing students' self-efficacy about caring for surgical patients in the clinical area. The exploration of a link between CAI and self-efficacy focused on the processes of learning, thereby extending the literature.

Adult↗
PubMed2004

Effects of computer-based clinical conferencing on nursing students' self-efficacy.

A pretest-posttest, quasi-experimental, control group design and Bandura's theory of self-efficacy were used to examine the influence of computer conferencing on fourth-year baccalaureate nursing students' self-efficacy for professional nursing competencies and computer-mediated learning (CML) during a final clinical practicum. Descriptive analysis was also used to explore themes regarding strengths and challenges of online learning. The convenience sample included 42 direct-entry students (control group: n = 27; online intervention: n = 15). Within both groups, there was a significant difference in self-efficacy for nursing competencies from pretest to posttest. However, between-group posttest scores were not significantly different. Computer conferencing enhanced learning, and students' self-efficacy for CML increased at posttest. Strengths of CML included connection, support, learning, and sharing. Challenges involved time and Internet access. Insights gained may assist educators in curriculum development when considering how CML strategies support clinical courses and strengthen learning communities.

Adult↗
PubMed2005

The effect of teaching method on objective test scores: problem-based learning versus lecture.

This study investigated the effect of teaching method on objective test scores of students in a school of nursing. The hypothesis stated there was a difference between objective test scores of students who were taught content on diabetes using problem-based learning (PBL) and students taught the same content using the traditional lecture method. Junior nursing students enrolled in the Adult Health I nursing course in the fall of 2001 were taught the diabetes content using lecture as the teaching method, while students enrolled in the same course in the spring of 2002 were taught the same content using PBL. A pretest and posttest were administered to both groups of students. Both the pretest and posttest scores of the two groups were compared using an independent t test, and no statistically significant difference was found in the scores of the two groups. The results of this study support the null hypothesis: that there is no difference in objective test scores based on teaching method (lecture versus PBL).

Adolescent↗
PubMed2005

[The persuasive effects according to types of exercise promotion advertisements for obesity prevention in elementary school students].

PURPOSE: This study was to identify the persuasive effects of exercise promotion advertisements for obesity prevention according to the source types(ordinary people, experts, celebrity endorsers) and advertising message types(slices of life, testimonials). METHOD: Gender, height, body weight, BMI, attitude toward obesity(Aob) and exercise(Aex), and intention to exercise(Iex) were collected from 626 elementary school students in a pretest. After 2 months, six advertisements type attached to a questionnaire were provided for 20 minutes and then Aob, Aex, Iex, source credibility and attitude toward advertisements(Aad) were collected in posttest. RESULT: 1) In posttest the Iex of 6 the groups increased significantly compared with that of the pretest, 2) Source credibility of the Ordinary+Testimonial group was lower than the Celebrity+Testimonial, Celebrity+Slice of life, Ordinary+Slice of life, and Expert+Testimonial groups. Aad of the Celebrity+Testimonial group was higher than the Ordinary+ Testimonial group. 3) The Main effect and interaction effect of source types and advertising message types were significant in source credibility and Aad. CONCLUSION: Persuasive effects of exercise promotion advertisements in elementary school students was found to be the most effective in Celebrity+Testimonial. This study suggests that selection of health education advertisements according to demographic characteristics is important to promote persuasive effects.

Advertising↗
PubMed2006

[Guided imagery types on stress and performance of an intramuscular injection of nursing students].

PURPOSE: The purpose of this study was to compare the feeling state guided imagery(FSGI) and end state guided imagery(ESGI) on stress and performance of an intramuscular injection of nursing students. METHOD: The design was a time series with a nonequivalent control group pretest-posttest study. Data was collected from the 23rd to the 25th of Nov. 2004. The subjects of this study were 40 female sophomores (21 for the ESGI, 19 for the FSGI). The instruments used in this study were the Visual Analogue Scale for Stress and the Nursing Skill Performance Check-list on Intramuscular Injection developed by the researchers(10 items). Guided imagery was provided through audiotapes for 8 minutes. A pretest was given before applying the guided imagery, posttest 1 was performed after the intervention, posttest 2 was performed before the intramuscular injection and then evaluation of the performance of the intramuscular injection was done. Data was analyzed using t-test, and Repeated Measures ANOVA. RESULT: The level of stress for those who received the ESGI and FEGI was not significant and the level of the nursing skill performance for those who received the ESGI was significantly higher than that of students who received the FEGI. CONCLUSION: The use of ESGI has an effect on learning psychomotor nursing skills and further research is needed on stress.

Adult↗
PubMed1990

[The effect of supportive nursing care on depression, mood and satisfaction in military patients with low back pain].

Support has always been considered an important nursing concept. However, there is no agreement among nurse researchers as to a conceptual definition of supportive nursing or meaningful supportive behaviors. Clarification of the concept, support in nursing, is necessary to promote communication among nurses on nursing behaviors that are effective in providing support and on understanding the relevant properties and characteristics of the concept, supportive nursing care. The objectives of the study were: 1. to analyze the concept, support in nursing, in order to provide a definition of supportive nursing care, and 2. to operationalize the definition of supportive nursing care and use it as an experimental nursing intervention for patients with low back pain. The first part of the study used the concept analysis approach developed by Walker and Avant (1983) to define the concept of supportive nursing care. The properties of supportive nursing care, defined by this analysis, included perception of supportive need, reciprocal interaction (Transaction), listening, providing empathy and information related to health, and confirmation of the patient's verbal and non-verbal response. The second part, the experimental part of the study, was done using King's(1970) Interpersonal Theory for Nursing. The concept, supportive nursing care, as defined in the concept analysis was operationalized and used as the experimental intervention. The experiment tested the effectiveness of the independent variable, supportive nursing care on the dependent variables, depression, mood and patient satisfaction, in the patients with low back pain in army hospitals. The instruments used to measure the dependent variables were Zung's(1965) Self-Rating Depression Scale, Ryman and Colleagues' (1974) Mood Questionnaire and LaMonica and Colleagues' (1986) Patient Satisfaction Scale. The experimental design used for this study was a Solomon 4 group experimental design. This design has the strength of allowing for observation of the main effects of supportive nursing care and pretesting, and for observation of the interaction effects of pretesting and supportive nursing care. The design includes one experimental group and three control groups. The Subjects of this study were 150 young male patients with low back pain on Neuro-Surgical Wards in three general army hospitals. There were 35 in the experimental group, 39 in the pre-posttest control group, 36 in the treatment-posttest control group and 40 in the posttest only control group. Supportive nursing care, as operationalized by the researcher according to the concept analysis, was given to the patients in the experimental group and the treatment-posttest control group, individually for 30 minute sessions, every other day for 5 days.(ABSTRACT TRUNCATED AT 400 WORDS)

Affect↗
PubMedDate not supplied

Value of Doppler ultrasonography in management of patients with follicular thyroid biopsy specimens.

OBJECTIVE: To perform a statistical evaluation with use of Bayes' theorem, evaluating the prognostic value of Doppler flow analysis, to determine the probability of cancer in thyroid nodules with a prior follicular biopsy specimen. METHODS: The medical literature was reviewed to identify studies in which ultrasonographic Doppler flow analysis was performed on thyroid nodules with a prior fine-needle aspiration biopsy sample showing follicular cytologic features. For inclusion in the study, all nodules must have had pathologic confirmation of the final diagnosis. The pretest probability of cancer was considered to be the incidence of carcinoma within the population studied. The posttest or conditional probability was calculated by using Bayes' theorem. RESULTS: Two well-designed prospective studies met the criteria for inclusion. The sensitivity of demonstration of intranodular flow by Doppler analysis for detection of thyroid carcinoma ranged from 80% to 86%. The specificity of intranodular flow indicating cancer ranged from 85% to 89%. The incidence of thyroid cancer (pretest probability) ranged from 12% to 14%. Application of Bayes' theorem indicated that the posttest probability of thyroid cancer declined to 3% when no central intranodular flow was present and increased to nearly 50% in the presence of intranodular flow. CONCLUSION: Doppler flow analysis, when performed on thyroid nodules with follicular cytologic findings on fine-needle aspiration biopsy, can provide extremely useful information regarding the probability of malignant involvement. This information can be used in the decision-making process about the need for, and the extent of, surgical resection of follicular lesions.

Bayes Theorem↗
PubMedDate not supplied

Efficacy of a video for teaching patients about prostate cancer screening and treatment.

PURPOSE: To test the effectiveness of a video to teach patients about prostate cancer screening and treatment in a clinic setting. METHODS: A staged, two-group, pretest-posttest quasi-experimental design was used. Questionnaires were completed before and after a routine doctor's appointment in a Veteran's Administration clinic. The experimental group (n = 52) viewed the video, and the control group (n = 52) received usual care only. The two groups were similar in age, education, race, and quality of life. RESULTS: Knowledge increased significantly from pretest to posttest for the experimental group, but not for the control group (p < .001). More patients in the experimental group changed their preference for prostate-specific antigen (PSA) screening (31% experimental vs. 2% control, p = .002), indicating the patients were impacted by the information presented. Viewing the video did not stimulate increased discussion with the physician or lengthen appointment time. CONCLUSION: The video was effective in improving knowledge about a complex topic and changing some patients' preference for PSA testing without frightening or confusing patients.

Aged↗
PubMed1986

The effects of introducing the Klein-Bell ADL Scale in a rehabilitation service.

This study investigated the impact of introducing the Klein-Bell ADL Scale into a rehabilitation medicine service. A pretest and a posttest questionnaire of rehabilitation team members and a pretest and a posttest audit of occupational therapy documentation were completed. Results of the questionnaire suggested that the ADL scale influenced rehabilitation team members' observations in the combined area of occupational therapy involvement in self-care, improvement in the identification of treatment goals and plans, and communication between team members. Results of the audit suggested that the thoroughness and quantification of occupational therapy documentation improved. The clinical implications of these findings recommend the use of the Klein-Bell ADL Scale in rehabilitation services for improving occupational therapy documentation and for enhancing rehabilitation team effectiveness.

Activities of Daily Living↗
PubMed1994

The effect of occupational therapy education on students' perceived attitudes toward persons with disabilities.

OBJECTIVES: The effect of occupational therapy education on students' perceived attitudes toward persons with disabilities was studied. METHOD: The perceived attitudes of 144 occupational therapy students toward persons with disabilities were measured before (retrospective pretest) and after (posttest) the students attended formal professional education at the University of Alberta. RESULTS: Posttest scores were significantly higher than the retrospective pretest scores, indicating that students' attitudes became more positive after they commenced formal professional education. The posttest scores of students at various levels of education, however, did not show any significant difference. CONCLUSION: On the basis of these observations, a positive but nonlinear relationship between occupational therapy education and attitudes toward persons with disabilities was postulated.

Attitude↗
PubMedDate not supplied

Outcomes associated with a summer handwriting course for elementary students.

OBJECTIVE: The purpose of this study was to examine the benefits of a summer handwriting instruction course offered to community elementary-age students. METHODS: Twenty-six students participated in the study and attended instruction for 1 hour per day for 2 weeks. Pre- and posttesting with the Evaluation Tool of Children's Handwriting (ETCH) were conducted. Parents were also asked to rate their child's handwriting at pretest, posttest, and 3 months posttest. RESULTS: Participants made significant improvement in two subtests of the ETCH and in parent ratings between pretest and posttest. Parent ratings remained significantly improved 3 months posttesting. Additional results suggest that children who received special education during the previous school year improved their handwriting scores on the ETCH to a greater degree than those who did not receive special education. CONCLUSION: A new service delivery model for handwriting instruction has the potential to benefit students. Occupational therapists should consider offering handwriting training to students in the summer especially if deterioration of performance is anticipated.

Child↗
PubMed2006

Learning outcomes and behavioral changes with a pharmacy continuing professional education program.

OBJECTIVE: To examine the results of an interactive curricular-based 3-month long pharmacy continuing professional education (CPE) program on short- and long-term learning outcomes and behavioral changes of current and potential preceptors. METHODS: A CPE program was developed that covered specific disease states and teaching skills. The goals of the course were to provide knowledge and skills needed to precept the College's new advanced rotations, and to attract more pharmacists to serve as preceptors. The course included pre-readings and 3-hour long workshops over a 3-month period of time. Learning and behavior were assessed by a pretest and posttest and follow-up survey. RESULTS: Ninety-nine pharmacists completed the course. Fifty participants completed the assessments and were included in the analysis, yielding a usable response rate of 52%. However, only 30 participants completed the follow-up survey instrument, resulting in a response rate of 30%. There was a significant increase in test scores between the pretest and posttest, but a significant decline in test scores between posttest and the follow-up survey. CONCLUSIONS: An interactive, curricular-based pharmacy CPE program is effective in increasing learning, but participants may not maintain the acquired knowledge over time. The program was not an effective mechanism to attract pharmacists to serve as preceptors.

Behavior↗
PubMed2000

Genetic testing for Alzheimer's disease.

Genetic factors are important in the development of Alzheimer's disease (AD). Familial AD can result from rare mutations in some genes. Other genes, such as the apolipoprotein E gene (APOE), operate as risk factors for late-onset sporadic AD. On a background of advances in the genetics of AD we suggest a way in which genetic information may be used in the diagnosis of AD. If there is a positive family history of early-onset dementia and the clinical features suggest AD, patients may be tested for presenilin and amyloid precursor protein gene mutations with appropriate pretest and post-test counselling. Predictive testing should be performed under guidelines developed by the World Federation of Neurology and the Human Genetics Society of Australasia. The usefulness of APOE genotyping as an adjunct to conventional diagnostic tests is unknown; data suggest it has low sensitivity and specificity and may have little predictive value in an individual patient. APOE genotyping should not be performed in asymptomatic individuals, except as part of an ethically approved research project; this recommendation is supported by a number of international consensus statements. APOE testing should not be used as a diagnostic test without adequate pretest and post-test counselling, education and support. APOE testing should not be used as a sole diagnostic test in the work-up of patients with AD. Genetic risk factors other than APOE require validation and should not be used routinely, except as part of an ethically approved research protocol.

Aged↗
PubMed2005

Venous thromboembolism: diagnosis and management of pulmonary embolism.

Pulmonary embolism (PE) affects 0.5-1 per 1000 people in the general population each year, and is one of the most common preventable causes of death among hospitalised patients. The clinical diagnosis of PE is unreliable and must be confirmed objectively with ventilation perfusion scanning or computed tomography pulmonary angiography. The diagnosis of PE can be reliably excluded, without the need for diagnostic imaging, if the clinical pretest probability for PE is low and the D-dimer assay result is negative. The initial treatment of PE is low-molecular-weight heparin or unfractionated heparin for at least 5 days, followed by warfarin (target international normalised ratio [INR], 2.0-3.0) for at least 3-6 months. Patients with a high clinical pretest probability of PE should commence treatment immediately while awaiting the results of the diagnostic work-up. Thrombolysis is indicated for patients with objectively confirmed PE who are haemodynamically unstable. Percutaneous transcatheter or surgical embolectomy may be life-saving in patients ineligible for, or unresponsive to, thrombolytic therapy. Unresolved issues in the management of venous thromboembolism include the roles of thrombophilia testing, thrombolysis for the treatment of stable PE patients who present with right ventricular dysfunction, and new anticoagulants; and the duration of anticoagulation for first unprovoked venous thromboembolism.

Angiography↗
PubMed2004

The effect of a 13-hour curriculum to improve residents' teaching skills: a randomized trial.

BACKGROUND: Although resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001-2002 found that 13 trained resident teachers taught better than did untrained control residents. OBJECTIVE: To determine whether a longitudinal residents-as-teachers curriculum improves residents' teaching skills. DESIGN: Randomized, controlled trial from May 2001 to February 2002 (pilot trial) and March 2002 to April 2003. SETTING: 4 generalist residencies affiliated with an urban academic medical center. PARTICIPANTS: 62 second-year residents: 23 in the 2001-2002 pilot trial and 39 more in 2002-2003; 27 of the 39 participants were medicine residents required to learn teaching skills. INTERVENTION: A 13-hour curriculum in which residents practiced teaching and received feedback during 1-hour small-group sessions taught twice monthly for 6 months. MEASUREMENTS: A 3.5-hour, 8-station, objective structured teaching examination that was enacted and rated by 50 medical students before and after the intervention. Two trained, blinded raters independently assessed each station (inter-rater reliability, 0.75). RESULTS: In the combined results for 2001-2003, the intervention group (n = 33) and control group (n = 29) were similar in sex, specialty, and academic performance. On a 1 to 5 Likert scale, intervention residents outscored controls on overall improvement score (post-test-pretest difference, 0.74 vs. 0.07; difference between intervention and control groups, 0.68 [95% CI, 0.55 to 0.81]; P < 0.001) by a magnitude of 2.8 standard deviations and on all 8 individual stations. The intervention residents improved 28.5% overall, whereas the scores of control residents did not increase significantly (2.7%). In 2002-2003, 19 intervention residents similarly outscored 19 controls (post-test-pretest difference, 0.83 vs. 0.14; difference between intervention and control groups, 0.69 [CI, 0.53 to 0.84]; P < 0.001). Twenty-seven medicine residents required to learn teaching skills achieved scores similar to those of volunteers. LIMITATIONS: The study was conducted at a single institution. No "real life" assessment with which to compare the results of the objective structured teaching examination was available. CONCLUSIONS: Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.

Curriculum↗
PubMed2005

Meta-analysis: test performance of ultrasonography for giant-cell arteritis.

BACKGROUND: Giant-cell arteritis is a diagnostic challenge. PURPOSE: To determine the diagnostic performance of ultrasonography for giant-cell arteritis. DATA SOURCES: Studies published up to April 2004 in the MEDLINE, EMBASE, and Cochrane databases; reference lists; and direct contact with investigators. STUDY SELECTION: Studies in any language that examined temporal artery ultrasonography for diagnosis of giant-cell arteritis, enrolled at least 5 patients, and used biopsy or the American College of Rheumatology (ACR) criteria as the reference standard. DATA EXTRACTION: Two reviewers independently graded methodologic quality and abstracted data on sensitivity and specificity of ultrasonography for giant-cell arteritis. Diagnostic performance was determined for the halo sign, stenosis, or occlusion and for any of these ultrasonographic abnormalities. DATA SYNTHESIS: Weighted sensitivity and specificity estimates and summary receiver-operating characteristic (ROC) curve analysis were used. Twenty-three studies, involving a total of 2036 patients, met the inclusion criteria. The weighted sensitivity and specificity of the halo sign were 69% (95% CI, 57% to 79%) and 82% (CI, 75% to 87%), respectively, compared with biopsy and 55% (CI, 36% to 73%) and 94% (CI, 82% to 98%), respectively, compared with ACR criteria. Stenosis or occlusion was an almost equally sensitive marker compared with either biopsy (sensitivity, 68% [CI, 49% to 82%]) or ACR criteria (sensitivity, 66% [CI, 32% to 89%]). Consideration of any vessel abnormality nonsignificantly improved diagnostic performance compared with ACR criteria. Between-study heterogeneity was significant, but summary ROC curves were consistent with weighted estimates. When the pretest probability of giant-cell arteritis is 10%, negative results on ultrasonography practically exclude the disease (post-test probability, 2% to 5% for various analyses). LIMITATIONS: The primary studies were small and of modest quality and had considerable heterogeneity. CONCLUSION: Ultrasonography may be helpful in diagnosing giant-cell arteritis, but cautious interpretation of the test results based on clinical presentation and pretest probability of the disease is imperative.

Adult↗
PubMed1981

Utility of the fluorescent antinuclear antibody test in a single patient.

The literature on the fluorescent antinuclear antibody (FANA) test, commonly used in diagnosing systemic lupus erythematosus, was analyzed. The specificity of the test reported in early descriptive studies is much greater than the value obtained when the test is used in clinical practice. The probability of systemic lupus erythematosus in a specific patient was determined when different numbers of the classification criteria developed by the American Rheumatism Association are present. The predictive value of a positive or negative FANA test result was calculated using different pretest probabilities based on clinical criteria. The marginal benefit of the FANA test was determined as minimal at points of very large and very small pretest probability of systemic lupus erythematosus, and as maximal when five clinical criteria are present.

Antibodies, Antinuclear↗
PubMed1998

Making the diagnosis of osteomyelitis. The role of prevalence.

Clinicians may have poor sensitivity in determining whether a given diabetic patient with a foot ulcer has osteomyelitis. Thus many turn to diagnostic tests. The literature was reviewed and data on the sensitivity and specificity of five commonly used diagnostic tests were compiled. Using Bayes' theorem, the authors' analysis suggests that pretest probability may be more important in the decision-making process than individual test characteristics. Also, a positive probe-to-bone test is as predictive of osteomyelitis as the other four tests. A negative magnetic resonance imaging test most likely rules out osteomyelitis. Interpretation of any test result is greatly influenced by the pretest probability of disease. Future work needs to focus on aiding the clinician in determining the patient's probability of disease prior to testing in order to optimize patient care.

Bayes Theorem↗