Revitalizing the Muddiest Point for Formative Assessment and Student Engagement in a Large Class.

BACKGROUND: Ascertaining student understanding can be challenging in large-enrollment and hybrid or asynchronous courses. PROBLEM: Instructors needed an innovative instructional strategy to encourage student engagement and support learning in a large-enrollment, mixed-format pathophysiology class. APPROACH: A weekly, graded assignment was created by merging the formative assessment commonly referred to as the muddiest point (MP) with an asynchronous discussion board activity within the learning management system. Each week, students were required to submit a question and respond to a peer. Instructors created a remediation lecture based on the most common student questions. OUTCOMES: The majority of students reported they benefitted from the MP discussion boards and remediation lectures. CONCLUSIONS: The MP discussion board activity is a flexible, instructional strategy to determine areas of confusion, increase student engagement, and facilitate learning in large-enrollment classes offered in multiple formats.

Assessing and Addressing Fundamentals of Social Determinants of Health Factors in Kidney Transplant Candidates and Recipients.

Non-medical factors can have a positive or negative effect on health outcomes and equity. These social determinants of health can play a role in patients' risk of developing kidney failure, as well as their access to kidney transplantation and long-term allograft survival. Nephrology nurses have the opportunity to identify and address negative social determinants of health factors in their patients because they are often patients' first contact in the nephrology setting. The purpose of this article is to promote nephrology nurses' and other nephrology health care providers' understanding of social determinants of health factors, and the fundamental practices for addressing them among kidney transplant candidates and kidney transplant recipients.

Faculty Perceptions of the Importance of Physical Assessment Skills Taught in Prelicensure Nursing Education.

BACKGROUND: Physical assessment skills are key components of nursing practice. On average, nurses perform a head-to-toe assessment 4 times during a shift. The frequency and importance of this technique have resulted in controversy in determining the essential components of assessment to ensure readiness for practice. PURPOSE: The purpose of the study was to explore the perceived importance by faculty for physical assessment skills taught in prelicensure nursing education programs. METHODS: This was a cross-sectional descriptive study using a 136-item questionnaire. The sample was nursing faculty (n = 402) teaching in an accredited nursing program in the United States. RESULTS: Among the physical assessment skill categories, integumentary (4.57 ± 0.51), central nervous (4.29 ± 0.62), and cardiovascular (4.20 ± 0.51) systems had the highest mean scores for the perceived level of importance of skill categories to be taught to prelicensure nursing students. CONCLUSION: The data suggest that faculty perceive physical assessment skills associated with the integumentary, central nervous, and cardiovascular systems to be the most critical skills taught in a nursing assessment course.

An Exploratory Correlational Study in the Use of Mobile Technology Among Adult Kidney Transplant Recipients.

INTRODUCTION: Rapidly growing use of mobile technology provides a platform for self-management of care support for those with chronic conditions. Few studies have explored the characteristics or access patterns of kidney transplant recipients who use mHealth applications (apps) for self-management of care. RESEARCH QUESTIONS: The primary aim of this study was to describe demographics, use, barriers, and perceptions of mobile apps for self-management of care among adult kidney transplants recipients. The secondary aim was to compare blood urea nitrogen, glomerular filtration rate, and number of hospitalizations among mHealth app users, other app users, and non-app users. METHODS: A cross-sectional design was used to administer the Mobile Application Use among Kidney Transplant Recipients Questionnaire. Descriptive statistics, χ2 statistics, and analysis of variance were used for the primary aim and linear regression was used for the secondary aim. RESULTS: The sample included mostly African American males (n = 123, 75.5%) with a mean age of 50 (13.2) years. Knowledge was the greatest barrier reported by the non-app users (mHealth app users 9%, other app users 12%, non-app users, 49%, P < .001). Significantly fewer hospitalizations were found in the mHealth app users compared to other app users (regression coefficient b = -1.2, standard error [SE] = 0.5) and non-app users ( b = -0.9, SE = 0.6), adjusting for patient demographic and clinical characteristics. DISCUSSION: Findings suggest a relationship may exist between mHealth app use and a decrease in the number of hospitalizations following kidney transplantation.

Postpartum assessment of the renin angiotensin system in women with previous severe, early-onset preeclampsia.

CONTEXT: Women with a history of severe preeclampsia are at an increased risk for the development of vascular disease. OBJECTIVE: We hypothesized that abnormalities in the renin-angiotensin system (RAS) may be a predisposing factor. DESIGN AND SETTING: Physiological assessments were conducted at an academic center. PARTICIPANTS: Sixteen women with previous severe preeclampsia (PPE) were compared with nine previously pregnant controls (PPC) and 11 never-pregnant controls (NPC). INTERVENTIONS: Baseline circulating components of the RAS and expression of angiotensin (ANG) II type I (AT1) and type II (AT2) receptors in the skin were assessed along with the response to simulated orthostatic stress using incremental lower-body negative pressure (LBNP: -15, -25, and -40 mm Hg) and a graded ANG II infusion (1 and 3 ng/kg · min). MAIN OUTCOME MEASURES: Response to LBNP and ANG II was evaluated. RESULTS: RAS components were not different between previously pregnant groups, but were decreased compared with NPC subjects. In response to LBNP, there were significant increases in RAS components in all three groups, but the response to this stimulus was significantly lower and delayed in PPE subjects. Despite the blunted rise in circulating RAS mediators in PPE subjects, their blood pressure was maintained in 88% compared with only 33 and 55% in the PPC and NPC groups, respectively (P = 0.014). All three groups responded to the graded ANG II infusion with an increase in blood pressure that was significantly more pronounced in PPE subjects (P = 0.037) correlating with AT1/AT2 receptor expression. CONCLUSIONS: Alterations in the RAS in formerly preeclamptic patients may contribute to future vascular disease.