Auditory training for adults with cochlear implants: a systematic review.

OBJECTIVE: To systematically review the peer-reviewed literature on the efficacy of auditory training (AT) on auditory outcomes in post lingually deafened adults with cochlear implants (CIs). DESIGN: A systematic review. STUDY SAMPLE: Searches of five electronic databases yielded 10 studies published after 2010 that met the inclusion criteria. RESULTS: For post lingually deafened adults with CIs, the evidence is suggestive that some AT can improve some auditory outcomes compared to no training. More specifically, the evidence suggests that phonemic training can improve identification of trained phonemes, and nonsense word training can improve sentence recognition in noise in this population. CONCLUSIONS: While many AT interventions are currently being used with post lingually deafened adults with CIs, the evidence for AT improving auditory outcomes is suggestive with the best evidence being for nonsense word training improving sentence recognition in noise by an average of 10% with these improvements retained at 26 weeks post-training in this population. There remains a need for high quality studies that have the capacity to demonstrate, clearly and unequivocally, which AT is most effective for improving which auditory outcomes in this population.

Beyond exposure therapy: formulation-based therapy treating a fear of urinary incontinence - a case study.

BACKGROUND: The current literature on the specific phobia of urinary incontinence is limited, with no specific empirically established model or treatment protocol. AIMS: This article consists of a case study of formulation-driven cognitive behaviour therapy (CBT) for phobia of urinary incontinence. METHOD: Martin attended a total of 12 treatment sessions. The treatment included the development of an idiosyncratic formulation, and the use of well-established cognitive and behavioural treatment strategies from other anxiety disorders. RESULTS: Both outcome measures and Martin's subjective report indicate that the treatment was effective. CONCLUSION: This case study contributes to the current limited literature on this phobia, and emphasises the importance of formulation-driven CBT to map for idiosyncratic features and target cognitive and behavioural factors.

Twelve tips for interfacing with the new generation of medical students: iGen.

iGen, or Generation Z, is the newest generation of health professions students to enter the classroom. This generation represents the first cohort of students in which technology has been present in all aspects of their lives. Since birth, they have been influenced by the boom of social media and wide-spread internet availability, leading to decreased face-to-face interactions and a desire for immediate access to information. Health professions educators should recognize the unique attributes of iGen students in order to foster student success and create a more positive learning environment. The following twelve tips examine the research-based distinctive characteristics of iGen students and highlight important concepts to consider when modifying current pedagogy to better support their needs. Incorporating these tips as an educator can promote lifelong learning and skill development for iGen students and empower this generation to thrive.

Chemotherapy-induced nausea and vomiting control in pediatric patients receiving ifosfamide plus etoposide: a prospective, observational study.

PURPOSE: Little evidence exists regarding the emetogenicity of chemotherapy in pediatric patients. This study describes the prevalence of chemotherapy-induced nausea and vomiting (CINV) in pediatric patients receiving etoposide plus ifosfamide over 5 days, a common pediatric regimen. METHODS: English-speaking, non-chemotherapy-naïve patients aged 4 to 18 years about to receive etoposide 100 mg/m2/day plus ifosfamide 1800 mg/m2/day over 5 days participated. Antiemetic prophylaxis was determined by each patient's care team. Emetic episodes were recorded and nausea severity was assessed by patients beginning with the first chemotherapy dose, continuing until 24 h after the last chemotherapy dose (acute phase) and ending 7 days later (delayed phase). The proportion of patients experiencing complete acute CINV control (no nausea, no vomiting, and no retching), the primary study endpoint, was described. The prevalence of complete chemotherapy-induced vomiting (CIV) and chemotherapy-induced nausea (CIN) during the acute, delayed, and overall (acute plus delayed) phases; complete delayed and overall CINV control; and anticipatory CINV were also determined. RESULTS: Twenty-four patients participated; acute CINV was evaluable in 22. Most (75%; 18/24) received a 5-HT3 antagonist plus dexamethasone for antiemetic prophylaxis. Few (23%; 5/22) experienced complete acute CINV control. Complete acute CIV and CIN control were experienced by 57% (13/23) and 27% (6/22) of patients, respectively. Complete delayed CINV, CIV, and CIN control rates were 42% (8/19), 70% (14/20), and 42% (8/19), respectively. CONCLUSIONS: Our findings support the classification of etoposide 100 mg/m2/day plus ifosfamide 1800 mg/m2/day IV over 5 days as highly emetogenic. This information will optimize antiemetic prophylaxis selection and CINV control in pediatric patients.

Uterine Artery Pulsatility Index Assessment at <11 Weeks' Gestation: A Prospective Study.

OBJECTIVE: Mean uterine artery pulsatility index (meanUAPI) is commonly measured at 11-13+6 weeks to predict adverse pregnancy outcomes including hypertensive disorders and small-for-gestational age. The aims of this study were to establish a population-specific reference range for meanUAPI at <11 weeks, to determine if an abnormal meanUAPI at <11 weeks was associated with adverse pregnancy outcome, and to assess changes in meanUAPI between <11 weeks and 11-13+6 weeks. METHODS: A prospective cohort was examined at <11 weeks and at 11-13+6 weeks to develop reference ranges for meanUAPI. Based on these regression models, meanUAPI Z-scores were compared between outcome groups using a two-sample t test. Longitudinal changes in the meanUAPI between <11 and 11-13+6 weeks were assessed by two-way mixed ANOVA. RESULTS: Prior to 11 weeks, there was no significant difference in meanUAPI between normal (n = 622) and adverse (n = 80) outcomes (mean [95% CI]: 2.62 [2.57-2.67] and 2.67 [2.50-2.84], respectively; p = 0.807). At 11-13+6 weeks, meanUAPI was significantly higher in the adverse (n = 66) compared with the normal (n = 535) outcome group (mean [95% CI]: 1.87 [1.70-2.03] and 1.67 [1.63-1.72], respectively; p = 0.040). There was a statistically significant decrease (p < 0.0001) in meanUAPI between the two time points. CONCLUSION: MeanUAPI measured at <11 weeks' gestation does not appear to be a useful marker for the prediction of placental-related adverse pregnancy outcomes, supporting an argument for the prediction of risk at 11-13+6 weeks' gestation.

Outpatient High-dose Methotrexate for Osteosarcoma: It's Safe and Feasible, If You Want It.

BACKGROUND: High-dose methotrexate (HD MTX) is usually administered as an inpatient to those with osteosarcoma. We prospectively tested the safety and feasibility of administering HD MTX in the ambulatory setting. MATERIALS AND METHODS: In this single arm prospective observational study, eligible patients had previously completed 2 courses of HD MTX as an inpatient. On study, patients received MTX in hospital, discharged home and returned for daily assessment. Criteria to determine safety and feasibility included: (1) parent compliance with home instructions, (2) pump functioning/failure, and/or (3) admission for toxicity/noncompliance. Outpatient therapy was deemed feasible if <25% courses resulted in study event. Patient satisfaction was assessed. RESULTS: Six patients (median age, 13.5 y) with extremity osteosarcoma completed 35 courses of MTX. There were no study events-no hospitalizations or pump failures and all parents were compliant. The Data and Safety Committee concluded that with zero events in 35 courses, it was unlikely for outpatient MTX to be infeasible; study was thus terminated early. Participants reported value to stay out of hospital, permitted life to feel "more normal"; however, burden of daily commute to hospital was cited. CONCLUSIONS: The delivery of HD MTX is safe and feasible in patients with osteosarcoma.

First-trimester ultrasound features associated with subsequent miscarriage: A prospective study.

BACKGROUND: First-trimester miscarriage is common, with women increasingly offered an ultrasound scan early in the first trimester to assess the status of their pregnancy. Ultrasound is uniquely situated to significantly impact the clinical management of these women. AIMS: This study aims to determine whether there were any differences in the early ultrasound appearances of pregnancies that continued to be viable or resulted in miscarriage before 12 weeks gestation. MATERIALS AND METHODS: This was a prospective cohort study including ultrasound measurements: mean sac diameter (MSD), yolk sac diameter (YSD), crown-rump length (CRL), fetal heart rate (FHR), trophoblast thickness, trophoblast volume (TTV) and mean uterine artery pulsatility index (meanUAPI). Regression models were fitted for each parameter and Z-scores compared between cohorts that progressed or miscarried after the scan but before 12 weeks gestation. Logistic regression analysis was used to create a prediction model for miscarriage prior to 12 weeks gestation based on the standardised ultrasound measurements recorded during the early first-trimester scan. RESULTS: Comparison of Z-Scores for meanUAPI, TTV, FHR and MSD demonstrated significant variation between the two groups. The proposed logistic regression model resulted in an area under the receiver operator curve of 0.81. At a false-positive rate of 30%, the model resulted in a sensitivity of 76% (95% CI 64-89%). CONCLUSION: The combination of FHR, meanUAPI, TTV in a prediction model for miscarriage may prove to be of value for ongoing pregnancy management in the first trimester.

Concomitant Administration of High-dose Methotrexate and Low-dose Aspirin Without Any Delay in Methotrexate Clearance in a Patient With Osteosarcoma: A Case Report and Review of the Literature.

BACKGROUND: Methotrexate (MTX) is a commonly used agent in the treatment of oncology patients whose clearance depends on renal health maintaining glomerular filtration and tubular secretion. Thus concomitant use of other drugs that utilize the same mechanism of clearance are generally avoided as this may contribute to increased MTX-associated toxicity. OBSERVATION: Herein, we describe the use of low-dose aspirin with high-dose MTX in a patient with osteosarcoma. CONCLUSION: Concomitant aspirin use did not affect the clearance of high-dose MTX and the patient did not experience any MTX-related toxicity including mucositis or renal impairment.

Cognitive Behavioural Therapy for Paruresis or "Shy Bladder Syndrome": A Case Study.

BACKGROUND: Paruresis, or "shy bladder syndrome", is a relatively common anxiety disorder, yet little is known about the causes of, and effective treatments for this disabling condition. AIM: This report describes a case study in which a man (Peter) presenting with paruresis was treated using formulation-driven CBT, which aimed to address the idiosyncratic processes that were maintaining his anxiety and avoidance of urinating in public. METHOD: Peter attended 12 sessions of CBT including one follow-up session a month after treatment had ended. Treatment involved collaboratively developing an idiosyncratic case conceptualization (identifying longitudinal and cross-sectional factors involved in the development and maintenance of his difficulties), followed by a number of standard cognitive and behavioural interventions commonly used in evidence-based CBT protocols for other anxiety disorders. Peter completed sessional outcome measures of paruresis symptomatology, anxiety, depression, social anxiety and functional impairment. RESULTS: Peter subjectively found the intervention helpful and his scores on all of the outcome measures reduced over the course of his therapy, and were maintained at one month follow-up. CONCLUSIONS: This report adds to the scarce literature regarding effective treatments for individuals suffering with paruresis. Limitations of the design are acknowledged and ideas for further research in this area are discussed.

Poor chemotherapy-induced nausea and vomiting control in children receiving intermediate or high dose methotrexate.

PURPOSE: Chemotherapy emetogenicity is the most important known determinant of chemotherapy-induced vomiting (CIV) in children. However, direct evidence regarding the emetogenic potential of chemotherapeutic agents in children is limited. This study describes the prevalence of complete control of acute and delayed phase chemotherapy-induced nausea and vomiting (CINV) in children receiving methotrexate. The prevalence of anticipatory CINV is described, and risk factors for CINV are explored. METHODS: English-speaking children (4 to 18 years) receiving intermediate-dose (ID-MTX: >1 to <12 g/m(2)/dose) or high-dose methotrexate (HD-MTX: ≥12 g/m(2)/dose) participated in this prospective study. Emetic episodes, nausea severity, and antiemetic administration were documented for 24 h from the start of the methotrexate infusion (acute phase) and for up to a further 168 h (delayed phase). CINV prophylaxis was provided at the discretion of the treating physician. Anticipatory CINV was assessed in the 24 h preceding chemotherapy. Complete CINV control was defined as no emetic episodes and no nausea. RESULTS: Thirty children (mean age, 11.8 ± 4 years; ID-MTX, 20; HD-MTX, 10) completed the study. CINV prophylaxis included the following: ondansetron/granisetron plus dexamethasone or nabilone. Few patients experienced complete CINV control (ID-MTX: acute phase 20%, delayed phase 5%; HD-MTX: acute phase 0%, delayed phase 30%). Complete emesis control was higher (ID-MTX: acute phase 70%, delayed phase 50%; HD-MTX: acute phase 70%, delayed phase 60%). Anticipatory CINV was reported by 6/28 patients (21%). Patient age, sex, and history of motion sickness were not significant predictors of CINV. CONCLUSIONS: The poor complete CINV control rate in children receiving methotrexate confirms the classification of HD-MTX as highly emetogenic chemotherapy (HEC) and suggests that ID-MTX be reclassified as HEC.

Guardians' perceptions of caring for a dog with canine cognitive dysfunction.

BACKGROUND: Canine cognitive dysfunction (CCD) is a neurodegenerative disease that is difficult to diagnose, as its clinical signs are similar to those of other age-related conditions. The experience of caring for a senior dog with or without CCD is not well described. METHODS: Data were collected via an online survey. Using a mixed methods design, the level of CCD and burden of care were measured using validated tools, and open-ended questions gathered qualitative data. A general linear model showed the factors associated with guardian burden of care. RESULTS: Sixteen percent of guardians experienced a clinically significant burden of care. Factors associated with burden of care included severity of CCD, sleep location, guardian employment, household size, dog age, guardian age and the dog taking medication. Few dogs with CCD were prescribed CCD medications to ameliorate clinical signs. Euthanasia, strong attachment mitigating burden and the complexities of caregiving were themes presented by guardians. LIMITATIONS: Measures are based on self-reports and as such the usual limitations apply. CONCLUSIONS: The burden of caring for an older dog is greater if they have CCD. More attention to the treatment of senior dogs, including medications to reduce clinical signs of CCD, could improve the welfare of older dogs and decrease the clinical burden experienced by guardians.

Widening the Road to Health Professions Education: Expanding Access for Diverse and Underserved Populations.

The Spring 2023 Webinar Audio Seminar (WAS) of the International Association of Medical Science Educators (IAMSE), titled "Widening the Road to Health Professions Education: Expanding Access for Diverse and Underserved Populations," was designed to help health science educators explore innovative practices in recruiting and enrolling students from underserved populations into health sciences programs. From March 2, 2023, to March 30, 2023, this five-part webinar series was broadcast live to institutions and educators worldwide. This series helped participants learn about creating pathways for students to meet the unique needs of their communities.

Self-directed learning assessment practices in undergraduate health professions education: a systematic review.

PURPOSE: The goal of this systematic review was to examine self-directed learning (SDL) assessment practices in undergraduate health professions education. METHODS: Seven electronic databases were searched (PubMed, Embase, PsycINFO, ERIC, CINAHL, Scopus, and Web of Science) to retrieve English-language articles published between 2015 and July of 2022, investigating assessment of SDL learning outcomes. Extracted data included the sample size, field of study, study design, SDL activity type, SDL assessment method, number of SDL assessments used, study quality, number of SDL components present utilising the framework the authors developed, and SDL activity outcomes. We also assessed relationships between SDL assessment method and number of SDL components, study quality, field of study, and study outcomes. RESULTS: Of the 141 studies included, the majority of study participants were medical (51.8%) or nursing (34.8%) students. The most common SDL assessment method used was internally-developed perception surveys (49.6%). When evaluating outcomes for SDL activities, most studies reported a positive or mixed/neutral outcome (58.2% and 34.8%, respectively). There was a statistically significant relationship between both number and type of assessments used, and study quality, with knowledge assessments (median-IQR 11.5) being associated with higher study quality (p < 0.001). Less than half (48.9%) of the studies used more than one assessment method to evaluate the effectiveness of SDL activities. Having more than one assessment (mean 9.49) was associated with higher quality study (p < 0.001). CONCLUSIONS: The results of our systematic review suggest that SDL assessment practices within undergraduate health professions education vary greatly, as different aspects of SDL were leveraged and implemented by diverse groups of learners to meet different learning needs and professional accreditation requirements. Evidence-based best practices for the assessment of SDL across undergraduate healthcare professions education should include the use of multiple assessments, with direct and indirect measures, to more accurately assess student performance.

Implementation of an onboard COVID-19 vaccination programme: a university partnership to vaccinate seafarers.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused many seafarers to be stranded on their ships due to lack of access to a vaccine and fear of contracting the COVID-19 virus limiting their ability to work on the ship. Once COVID-19 vaccinations were available, a lack of access to the vaccine continued to exist in the underserved seafarer population. This lack of access to the COVID-19 vaccine meant that seafarers were sometimes unable to leave their ships for months beyond their original contracts. MATERIALS AND METHODS: The University of South Florida (USF) College of Nursing collaborated with the USF Morsani Colleges of Medicine and Pharmacy in the development and implementation of an onboard COVID-19 vaccination programme at the request of the Port of Tampa Ministries. RESULTS: In 6 months, 1237 seafarers from 30 countries and 5 continents received the COVID-19 vaccination as a result of this programme. CONCLUSIONS: Partnership between a commercial port and a College of Nursing at a local university enabled hundreds of seafarers to be vaccinated against COVID-19. This programme serves as a model for industry and academic partnerships that can have a global impact on health and wellness.

Innovative Opportunities for Nurse Practitioner Education Uncovered by the Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic resulted in the abrupt withdrawal of clinical sites for nurse practitioner (NP) students during the Spring semester of 2020. This situation necessitated the identification of innovative clinical opportunities to ensure advanced practice nursing students met course objectives and program requirements. METHOD: This article describes innovative clinical opportunities that met the needs of the community, including those impacted by the pandemic, and enabled NP students' progression toward completing clinical requirements. RESULTS: Participation in these unique opportunities provided more than 130 NP students with meaningful clinical experiences to increase competence in the care of vulnerable populations and communities during a public health crisis. CONCLUSION: Experiences supported competency development in the areas of leadership, clinical management, population health and infection control, policy and advocacy, informatics, telehealth, and ethical considerations while providing essential services to the community. These innovative clinical opportunities may be useful for graduate clinical programs worldwide. [J Nurs Educ. 2022;61(3):153-155.].

Teaching in Uncertain Times: Expanding the Scope of Extraneous Cognitive Load in the Cognitive Load Theory.

The COVID-19 pandemic caused an unprecedented and highly threatening, constrained, and confusing social and educational environment, we decided to expand the traditional focus of the extraneous load in Cognitive Load Theory (CLT) acknowledging the psychological environment in which learning occurs. We therefore adapted and implemented principles of the CLT to reduce extraneous load for our students by facilitating their educational activities. Given previous empirical support for the principles of CLT, it was expected that the adoption of these principles might enable our students to cultivate attitudes and skills across multiple domains such as online learning and presentation technologies, implementing and maintaining a "classroom atmosphere" in a virtual environment, participating in discussions among large online groups of students, facilitating group work, providing virtual office hours for students, and proactively planning for upcoming semesters.

Pandemic response: The identification of alternative clinical hours to ensure advanced practice nursing students meet program requirements.

ABSTRACT: The coronavirus (COVID-19) pandemic resulted in the abrupt withdrawal of clinical sites for advanced practice nursing students which worsened an already challenging placement process. Few studies to date have analyzed the use of alternative clinical practice experiences used to facilitate the completion of program requirements by advanced practice nursing students beyond direct hour requirements. The faculty team from one university decided to track and analyze their use of alternative clinical practice experiences for advanced practice nursing students actively enrolled during the first semester of the pandemic. The team collated student alternative hour entries within the clinical courses for review and statistical analysis. Data included input from advanced practice nursing students in family, pediatric primary care, adult gerontology primary care, adult gerontology acute care nurse practitioner concentrations, and nursing education, doctor of nursing practice, and nurse anesthesia programs. A total of 569 advanced practice nursing students participated in 15 distinct alternative clinical activities. There was a significant effect of students' program concentration on total number of virtual case study hours logged, F (6, 562) = 9.45, p < .0001, and a significant effect of students' program concentration on total number of continuing education hours logged, F (6, 562) = 7.79, p < .0001. Results can inform the use of concentration-specific alternative activities for advanced practice nursing students to address gaps in clinical experiences.

Back to the Future: Maximizing Student Learning and Wellbeing in the Virtual Age.

The virtual age of learning is no longer a concern of the future. It is here. The Fall 2021 Webinar Audio Series (WAS) of the International Association of Medical Science Educators (IAMSE), titled "Back to the Future: Maximizing Student Learning and Wellbeing in the Virtual Age," was designed to help health science educators equip themselves with tools to teach the next generation of health care professionals successfully. From September 2, 2021 to September 30, 2021, the Fall 2021 Series was broadcast live to audiences at academic institutions worldwide in five weekly webinars. This five-part webinar series explored theories and best practices in delivering content over virtual and online media while simultaneously promoting a positive learning environment and enhanced student wellbeing.

To Infinity and Beyond: Expanding the Scope of Basic Sciences in Meeting Accreditation Standards.

Interprofessional training, social sciences curricula, service-learning, pre-clerkship integration, and self-directed learning are all cornerstones of medical education and closely align with accreditation elements for most accreditation bodies within health professions education. As a sequel to the Winter 2022 series, the Spring 2022 Webcast Audio Seminar (WAS) of the International Association of Medical Science Educators (IAMSE) continued to examine the evolving roles of basic science educators. From March 3 to March 31, 2022, the five-part webinar series was broadcast live to audiences at academic institutions worldwide; recordings are available on the IAMSE website. This series built a framework through which basic scientists can leverage their content to meet various accreditation standards.

Time-intensive cognitive behaviour therapy for obsessive-compulsive disorder: A case series and matched comparison group.

OBJECTIVES: A time-intensive format may be both useful and effective for the delivery of cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD). Intensive treatments also offer a pragmatic alternative to in-patient admission for those in a geographically remote location. Published studies of intensive treatment include pioneering exposure-response prevention (ERP) trials that emphasized the requirement for high-intensity treatment; more recently several studies have used treatment protocols with a heavy emphasis on ERP. This study compares intensive versus standard weekly treatment format following the integrated formulation-driven CBT approach widely used in UK adult mental health settings. DESIGN: An analysis of patients undertaking intensive CBT using a matched comparison group of those who undertook weekly CBT for OCD. METHODS: Twenty-two adult patients undertook intensive format treatment (matched with a weekly group for age, gender, and initial symptoms). A range of self-report measures were examined at the end of treatment and at a 3-month follow-up. RESULTS: Significant treatment effects were found on a range of self-report measures; both conditions were found to be equally effective at the end of treatment and at 3-month follow-up. Uncontrolled effect sizes show that the intensive treatment was comparable to other trials of CBT for OCD. CONCLUSION: An intensive treatment format for the delivery of CBT for OCD was found to be as effective as weekly treatment. This is consistent with the recommendations from the National Institute for Clinical Excellence guidelines. This study adds to the growing literature on the effectiveness of intensive format treatment.