Virtual Simulations: A Creative, Evidence-Based Approach to Develop and Educate Nurses.

The use of virtual simulations in nursing is an innovative strategy that is increasing in application. There are several terms related to virtual simulation; although some are used interchangeably, the meanings are not the same. This article presents examples of virtual simulation, virtual worlds, and virtual patients in continuing education, staff development, and academic nursing education. Virtual simulations in nursing use technology to provide safe, as realistic as possible clinical practice for nurses and nursing students. Virtual simulations are useful for learning new skills; practicing a skill that puts content, high-order thinking, and psychomotor elements together; skill competency learning; and assessment for low-volume, high-risk skills. The purpose of this article is to describe the related terms, examples, uses, theoretical frameworks, challenges, and evidence related to virtual simulations in nursing.

Education as an Intervention Toward Recognizing and Eliminating Incivility.

Incivility in nursing is a pervasive and evasive problem that many nurses do not easily recognize or may simply shrug off as "normal." However, incivility produces a hostile work environment and can jeopardize safety. A study was conducted to (a) determine nurses' ability to recognize incivility in nursing after an online educational intervention on incivility, (b) ascertain the effectiveness of online education toward assisting nurses with understanding how to ward off this behavior, and (c) determine the types and effects of incivility participants experienced. Findings suggest that education on incivility may assist nurses with identifying uncivil behaviors exhibited by nurse peers and help them understand strategies to combat it. The types of incivility reported by participants were similar to findings of other studies; effects included unsafe behaviors and somatic consequences.

Biographic Characteristics and Factors Perceived as Affecting Female and Male Careers in Academic Surgery: The Tenured Gender Battle to Make It to the Top.

PURPOSE: Given the high attrition rate in the field of academic surgery, we aimed to characterise the professional and personal situations of female and male academic surgeons as well as to gather data on their respective perceptions of career advancement and work satisfaction. METHODS: We conducted a cross-sectional survey in Germany, inviting all identifiable academically highly qualified female surgeons and their male counterparts in a 1:2 ratio to participate. An anonymous 103-item online questionnaire was designed and the data collected between July and September 2014. RESULTS: The questionnaire was sent to 93 female and 200 male surgeons, of whom 63 women (67.7%) and 70 men (35.0%) replied. The average age was 47.5 and 47.1 years, respectively. Respondents identified 'high degree of expertise', 'ambition', and 'clarity of one's professional aims' as important factors affecting professional career development. Both groups felt 'workload', 'working hours/shifts', and 'gender' to be a hindrance, the latter of significantly greater importance to female surgeons. The mean work satisfaction scores were high in both female (69.5%) and male (75.7%) surgeons. The predictors 'support from superiors' (standardised ß coefficient = 0.41) and 'manual aptitude' (ß = 0.41) contributed incrementally to the variance in 'high degree of work satisfaction' (90-100%) observed for female surgeons. However, childcare provided by 'kindergarten/crèche/after-school care' had the greatest negative predictive value (ß = -1.33). CONCLUSIONS: Although there are many parallels, female faculty members experience the culture of academic surgery to some extent differently from their male counterparts, especially when impacted by parenthood and childcare. Faculty development programmes need to develop strategies to improve perceived equality in career opportunities by respecting individuals' requirements as well as offering gender-appropriate career guidance.

The United States Alpha-1 Foundation Research Registry: Genesis, Impact and Future.

The Alpha-1 Foundation Research Registry has a long history of facilitating research studies in the United States. The current contact registry is used to invite participants to research studies. However, the next generation of individuals diagnosed with alpha-1 antitrypsin deficiency may look quite different from historical cohorts. This paper uses data from the Alpha Coded Testing (ACT) study, a home genetic testing program in which deficient individuals are invited to participate in the Registry, to demonstrate the impact that selection bias can introduce into registry data. Environmental tobacco smoke (ETS) exposure is rapidly declining in the United States. We queried whether consecutive non-smokers with or without childhood ETS in ACT (N = 801) had been diagnosed with COPD more often if deficiency genes were defined in subsequent testing. The prevalence of COPD was not different between cohorts with or without ETS exposure between normal (PiMM and PiMS), moderately deficient (PiMZ, PiMNull, and PiSS), and severely deficient (PiSZ, PiZZ, PiSNull, and PiZNull) genotypes. Surprisingly, age adjusted COPD Severity Scores in this cohort were higher for individuals with normal genotypes compared to moderately (P<0.001) and severely (P = 0.04) deficient genotypes. Ascertainment bias of testing within families (which yields the highest incidence of deficiency genotypes) also finds many family members without symptoms, even over the age of 40. We conclude that the future utility of registries will depend on accurate determination of testing mechanics. Larger database initiatives using the COPD Patient Powered Research Network are described.

Perceived facilitators and barriers to baccalaureate degree completion among registered nurses with an associate's degree.

BACKGROUND: A strong movement is underway in the United States to increase the percentage of baccalaureate-prepared registered nurses (RNs). However, the percentage of associate's-prepared RNs who go on to pursue baccalaureate education remains low. The authors sought to determine facilitators and barriers that associate's-prepared RNs experience in progressing toward baccalaureate nursing education. METHOD: A convenience sample (n = 81) of associate's-prepared RNs was used to collect data on perceived facilitators and barriers to progression toward baccalaureate nursing education. RESULTS: Facilitators included a desire for personal growth, professional and career enhancement, programmatic and articulation friendliness, and encouragement by others. Barriers included family and job constraints, financial concerns, and lack of differential treatment between associate's-prepared RNs and baccalaureate-prepared RNs. CONCLUSION: Although at first glance the identification of four facilitators and three barriers may appear to indicate an advance toward progression to baccalaureate education, the magnitude of the barriers may outweigh that of the facilitators. Therefore, the magnitude of both facilitators and barriers is worthy of future study.

A novel antifolate suppresses growth of FPGS-deficient cells and overcomes methotrexate resistance.

Cancer cells make extensive use of the folate cycle to sustain increased anabolic metabolism. Multiple chemotherapeutic drugs interfere with the folate cycle, including methotrexate and 5-fluorouracil that are commonly applied for the treatment of leukemia and colorectal cancer (CRC), respectively. Despite high success rates, therapy-induced resistance causes relapse at later disease stages. Depletion of folylpolyglutamate synthetase (FPGS), which normally promotes intracellular accumulation and activity of natural folates and methotrexate, is linked to methotrexate and 5-fluorouracil resistance and its association with relapse illustrates the need for improved intervention strategies. Here, we describe a novel antifolate (C1) that, like methotrexate, potently inhibits dihydrofolate reductase and downstream one-carbon metabolism. Contrary to methotrexate, C1 displays optimal efficacy in FPGS-deficient contexts, due to decreased competition with intracellular folates for interaction with dihydrofolate reductase. We show that FPGS-deficient patient-derived CRC organoids display enhanced sensitivity to C1, whereas FPGS-high CRC organoids are more sensitive to methotrexate. Our results argue that polyglutamylation-independent antifolates can be applied to exert selective pressure on FPGS-deficient cells during chemotherapy, using a vulnerability created by polyglutamylation deficiency.

Culturally Responsive Teaching in Nursing Education: A Faculty Development Project.

Culturally responsive teaching is a vital skill for nurse educators. A diverse nursing workforce is needed in the US to represent the population's demographics. Recruiting, retaining, and engaging a diverse student body is critical to addressing issues of disparities and cultural sensitivity in health care. In a project to promote success among diverse nursing students, nurse educators collaborated to create and present faculty development programs to build culturally responsive teaching skills. This article includes examples of culturally responsive teaching and describes the project and the faculty development curriculum and teaching materials produced.

The Alpha-1 Association Genetic Counseling Program: an innovative approach to service.

In an era of specialty medicine, genetic counselors are becoming increasingly focused in their service provision. The Alpha-1 Association Genetic Counseling Program, established in September 2007, specializes in confidential toll-free genetic counseling provided by a certified genetic counselor for Alpha-1 Antitrypsin deficiency, a co-dominant condition associated with lung and/or liver disease. The program received more than 600 callers in its first 2 years. Sixty-seven percent of new callers were family members, carriers, or health professionals. The number of callers increased between the first 2 years, with the greatest increases being family members and health professionals. Testing options and explanation of results encompassed 60% of initial reasons for calls. Seventy-two percent of referrals came from family and friends, test result letters, and the Alpha-1 Association. Between year 1 and 2 family member referrals showed the largest increase. This disease-specific genetic counseling program provides a model that may be useful for other rare disease communities.

Communicative competencies anchored longitudinally - the curriculum "personal and professional development" in the model study programme in undergraduate medical education at the University of Witten/Herdecke.

Background: In October 2018, the University of Witten/Herdecke (UW/H) launched the new reformed medical education programme called Medicine 2018+. A major innovation compared to the existing model programme was the introduction of thematic focuses. A longitudinal communication skills curriculum was integrated into the new thematic focus "professional and personal development - inner work" (IAP). With the start of the new programme, the IAP curriculum has been built step-by-step over time, i.e. the first four semesters have already been implemented, the following semesters are being planned. Project description: IAP aims to provide students with patient-centred medicine. Five areas of competence were defined: Doctor-patient communication, team competence, staying healthy, my paths to becoming a doctor, medicine and society. The focus of this article is on the communication curriculum. The first year of study focusses on the training of basic communication skills. In the 2nd year of study, students practice these basic skills in small groups with simulated patients (SP), whereby the emphasis in the 3rd semester is on history taking and in the 4th semester is on sharing information. In the 3rd semester, students complete a communication station in an OSCE. From the 5th semester onwards, the focus of training is on the consolidation of basic and advanced communication skills, which can be applied in clinical clerkships, and the reflection of clinical experiences. Key didactic elements are, in addition to teaching the theoretical basics, experience-based small group work with and without SP, feedback and reflection. The evaluation of the summer semester 2020 showed high agreement ratings of the students regarding the overall satisfaction with the individual courses (83-100% agreement). Discussion: The introduction of IAP has been very positively received by the students. Challenges are the adequate handling of the increasing student workload when planning new courses, the implementation of a longitudinal e-portfolio as well as the recruitment and training of clinical teachers and SPs. Conclusion: As the evaluation results of the summer semester 2020 show, the first steps of implementing a longitudinal communication curriculum at UW/H have been successful. Helpful strategies were the orientation on published examples from other faculties as well as regular feedback and discussions with students and teachers in order to adapt and integrate educational considerations into the existing model programme in Witten.

To zoom or not to zoom - the training of communicative competencies in times of Covid 19 at Witten/Herdecke University illustrated by the example of "sharing information".

Since October 2018, a longitudinal communication curriculum for medical students has been implemented at Witten/Herdecke University. In the summer semester 2020, the concept for the 4th preclinical semester included a practical training on "sharing information", which consisted of three two-hour face-to-face sessions with simulated patients (SP). Due to the Covid 19 pandemic, teaching was changed to an inverted classroom concept combining asynchronous and synchronous teaching. The students worked at the beginning of the semester on an e-learning module of the learning platform docCom.deutsch on the topic "sharing information" using reflection and processing tasks. In two digital sessions, the students then were able to practice discharge interviews and discussions about risk communication illustrated by the example of screening methods for cancer prevention. In the first zoom session, students practiced in role-plays among themselves. In the second zoom session, they practiced with SP. The evaluation results revealed that 76% of the responding students considered working with the e-learning module as a good preparation for the interviews. According to the evaluation results, satisfaction with the Zoom meeting including SP contact was slightly higher than those with role-plays among themselves. Although the group atmosphere was rated by all responding students as conducive to learning, almost half of them confirmed that using Zoom significantly impaired the atmosphere (47%). In retrospect, the conversion of the communication training to a digital format worked better than expected from both the perspective of teachers and students. The students explicitly appreciated working with SP. From the teachers' perspective, some specific aspects of successful communication were difficult to reflect on, e.g. non-verbal communication. The use of e-learning as a preparation for practical exercises has proven successful and will be continued in the future.

Long-term effects of bouldering psychotherapy on depression: benefits can be maintained across a 12-month follow-up.

BACKGROUND: Previous studies have identified positive effects of Bouldering Psychotherapy (BPT) on symptoms of depression. The aim of the present study was to investigate the short- and long-term effects of BPT on 97 participants with depression. METHODS: BPT took place once a week over a period of 8 weeks. In a waitlist control group design, participants were assessed at baseline and after 8 weeks (end of BPT for the intervention group; start of BPT for the waitlist group), 16 weeks, and 12 months. The main outcome was severity of depression measured with the Beck Depression Inventory II (BDI-II). RESULTS: Depression scores dropped by 7.21 on the BDI-II during the first intervention period with a Cohen's d of 0.59. A regression analysis at t1 showed that group allocation (p < .001) was the only significant predictor besides the baseline depression score (p < .001). A 12-month (after t0) follow-up measurement showed that the decrease in depression severity remained stable during that time, with values of d = 0.37 for the intervention group and d = 0.43 for the waitlist group. LIMITATIONS: Limitations of the study are the assessment of symptoms via only self-report, the lack of a control group during follow-up, and different durations of the follow-up period in the two groups. CONCLUSION: Our results augment the findings of previous studies regarding the short-term effects of BPT and provide initial evidence that the positive effects of BPT on depression severity can be maintained across a period of 12 months.

Genetic testing of minors for alpha1-antitrypsin deficiency.

BACKGROUND: Alpha(1)-antitrypsin deficiency (AATD) is a genetic disorder primarily affecting the lungs and liver of affected individuals, causing severe panlobular emphysema and cirrhosis. OBJECTIVE: To describe the demographics and feasibility of a home test for AATD in children and adolescents. DESIGN: Case series of parents who test their children for AATD. SETTING: Nonprofit supported program in which participants telephoned or e-mailed requests for alpha(1)-antitrypsin testing. PARTICIPANTS: All persons younger than 18 years whose parents or guardians chose to test for AATD from January 1, 2002, to October 1, 2004. INTERVENTIONS: Home-administered finger-stick blood spot test for alpha(1)-antitrypsin genotype and questionnaire. MAIN OUTCOME MEASURES: The alpha(1)-antitrypsin genotypes and questionnaire responses. RESULTS: The Alpha Coded Testing Study tested 422 children and adolescents with a confidential test for AATD. Testing was suggested by a family member in most (76.7%) of the cases and was responsible for the many carrier (PIMZ and PIMS) genotypes (51.9%) in the study. Interest in testing was equally distributed among all ages. Test confidentiality was seen as an important reason to test (64.1% with a Likert scale score of 4-5 on a 5-point scale). Parents and guardians of the minors suggested that testing benefits (mean [SD] Likert score, 3.5 [1.4] on a 5-point scale) were higher than risks (mean [SD] Likert score, 1.7 [1.2]) (P=.001). CONCLUSION: Parents value genetic testing of their children at risk for AATD when testing can be done in a confidential setting.

Differential diagnosis of a fused wrist with a partially destroyed capitate from Kazakhstan (1st-3rd century AD).

We discuss here the differential diagnosis of carpal ankylosis along with the second and third metacarpals of the right hand in an adult male skeleton buried in a kurgan from Mayemer, Kazakhstan (86-242 AD, 95.4% cal.). Our assessment was conducted via macroscopic analysis as well as with the use of radiographic methods. Several groups of pathologies were considered: congenital diseases, inflammatory and infectious diseases, and trauma. Differential diagnosis was challenging due to the very poor preservation of the skeleton, and while several diseases are possible (e.g., rheumatoid arthritis, spondylarthropathy), we think the fusion is most likely of traumatic origin. Evidence for trauma was found, suggesting a scaphocapitate fracture syndrome, followed by ankylosis.

Detection of alpha-1 antitrypsin deficiency by respiratory therapists: experience with an educational program.

BACKGROUND: Alpha-1 antitrypsin deficiency is under-recognized. We hypothesized that respiratory therapists (RTs) could help improve the detection rate of individuals with alpha-1 antitrypsin deficiency. The American Association for Respiratory Care (AARC) and Alpha-1 Foundation recently collaborated to create an online alpha-1 antitrypsin deficiency training program for RTs. This study aimed to determine (1) the rate of RT enrollment in the training program, (2) the rates of detecting individuals with alpha-1 antitrypsin deficiency referred for testing by RTs who took the online course ("trained RTs"), and (3) the genotype distribution of referred individuals found to have alpha-1 antitrypsin deficiency. METHODS: Patients referred by trained RTs submitted blood samples for alpha-1 antitrypsin deficiency testing through the existing Alpha-1 Coded Testing (ACT) Study. The AARC sent the first 3 digits of trained RTs' zip codes to the study data center. Investigators there matched those zip codes with those of patients in the ACT Study who reported being referred to the study by an RT. The data center determined the number of these patients with alpha-1 antitrypsin deficiency and their genotypes. Investigators then aggregated the data and calculated the RT enrollment rate, the rate of detecting individuals with alpha-1 antitrypsin deficiency, and the distribution of genotype results. RESULTS: Between July 1, 2012, and June 30, 2013, 378 RTs took the online program (mean 21/mo), and 326 patients reported that they were referred for testing by an RT. Thirty-four percent (111/326) of these referrals were by trained RTs (6.2/mo). Sixty-two test blood kits were returned by these 111 referred patients and analyzed (4/mo). Two of these specimens (3.2%) were from patients identified as having severe alpha-1 antitrypsin deficiency (PI*ZZ) and one from a patient with PI*SZ (serum level 14 µM). Twenty-four percent were from PI*MZ heterozygotes. CONCLUSIONS: A program to educate RTs about alpha-1 antitrypsin deficiency was associated with referral of patients for alpha-1 antitrypsin deficiency testing and high rates of detecting individuals with severe alpha-1 antitrypsin deficiency.

Is PiSS Alpha-1 Antitrypsin Deficiency Associated with Disease?

Background. Alpha-1 antitrypsin deficiency (AAT) is an inherited condition that predisposes to lung and/or liver disease. Objective. The current study examined the clinical features of the PiSS genotype. Methods. Nineteen study participants (PiSS) and 29 matched control participants (PiMM) were telephone interviewed using a standardized questionnaire. Demographic features, cigarette smoking, vocation, medication history, and clinical diagnoses were compared. Statistical analysis was performed. Finally, a comprehensive literature review was performed by two investigators. Results. 12/19 (63.2%) study participants reported the presence of lung and/or liver disease compared to 12/29 (41.4%) control participants. There trended toward having a higher frequency of medication allergies in the study population (42.11% versus 20.69%). Conclusions. The PiSS genotype was associated with a similar incidence of obstructive lung disease to controls. Selective bias intrinsic in testing for AAT deficiency and the rarity of the PiSS genotype will make future study of this association dependent on population-based tests.