Chinese version of the clinical learning environment comparison survey: Assessment of reliability and validity.

BACKGROUND: Simulation is recommended as a substitute for clinical practice among nursing students. No current guidelines exist regarding the accurate percentage of simulation hours versus clinical practice hours. Comparing simulation with clinical practice is needed so that both strategies can be optimally combined in nursing education. The 29-item Clinical Learning Environment Comparison Survey (CLECS) is validated to compare the traditional and simulated clinical environment in meeting nursing students' learning needs. This type of tool is not available in China. OBJECTIVES: This study aimed to translate and test the psychometric properties of CLECS for Chinese undergraduate nursing students. DESIGN: This is a cross-sectional study. SETTINGS: Two nursing schools in Central and East China. PARTICIPANTS: A total of 179 undergraduate nursing students who had participated in both traditional and high fidelity simulated clinical practice were recruited. METHODS: A standard procedure with forward translation, back translation, cultural adaptation and pilot testing was followed to test the CLECS (Chinese version). An exploratory factor analysis was used to establish a modified factor structure of CLECS (Chinese version); a confirmatory factor analysis verified its construct validity. Reliability of the CLECS (Chinese version) was estimated using the intraclass correlation coefficients (ICCs) and Cronbach's alpha coefficients. RESULTS: The exploratory factor analyses explained 61.43% and 60.11% of the total variances in traditional and simulated clinical environment. The proposed factor solution of the CLECS (Chinese version) obtained satisfactory model fit and nesting model between two nursing schools. In the proposed model, ICCs were 0.61 and 0.93, and Cronbach's alpha coefficients were 0.75 and 0.95 in the traditional and simulated clinical environment. CONCLUSIONS: The CLECS (Chinese version) showed satisfactory reliability and validity among Chinese undergraduate nursing students. Further validation of the CLECS (Chinese version) is needed in a more representative and larger sample. The CLECS (Chinese version) should be further tested as an effective tool to compare the traditional and simulated clinical practice among Chinese nursing schools.

A simple prediction model to estimate obstructive coronary artery disease.

BACKGROUND: A simple noninvasive model to predict obstructive coronary artery disease (OCAD) may promote risk stratification and reduce the burden of coronary artery disease (CAD). This study aimed to develop pre-procedural, noninvasive prediction models that better estimate the probability of OCAD among patients with suspected CAD undergoing elective coronary angiography (CAG). METHODS: We included 1262 patients, who had reliable Framingham risk variable data, in a cohort without known CAD from a prospective registry of patients referred for elective CAG. We investigated pre-procedural OCAD (≥50% stenosis in at least one major coronary vessel based on CAG) predictors. RESULTS: A total of 945 (74.9%) participants had OCAD. The final modified Framingham scoring (MFS) model consisted of anemia, high-sensitivity C-reactive protein, left ventricular ejection fraction, and five Framingham factors (age, sex, total and high-density lipoprotein cholesterol, and hypertension). Bootstrap method (1000 times) revealed that the model demonstrated a good discriminative power (c statistic, 0.729 ± 0.0225; 95% CI, 0.69-0.77). MFS provided adequate goodness of fit (P = 0.43) and showed better performance than Framingham score (c statistic, 0.703 vs. 0.521; P < 0.001) in predicting OCAD, thereby identifying patients with high risks for OCAD (risk score ≥ 27) with ≥70% predictive value in 68.8% of subjects (range, 37.2-87.3% for low [≤17] and very high [≥41] risk scores). CONCLUSION: Our data suggested that the simple MFS risk stratification tool, which is available in most primary-level clinics, showed good performance in estimating the probability of OCAD in relatively stable patients with suspected CAD; nevertheless, further validation is needed.

[Impact and Challenges of Genetic Disorders on Nursing].

Genetic disorders greatly impact human life. Nursing staffs should provide counseling and health education before and after patients receive genetic testing. Current attitudes toward women who receive genetic tests emphasize respect patient autonomy and allowing the patient to make her own decisions regarding the tests she wants to take and her reproductive planning. For patients whose results include them in the high-risk group for dementia, providing mental support and counseling to assist them to understand the meaning of these results is important. One issue that deserves particular attention is the supervision of genetic testing agencies. Although the credibility, testing fees, and professionalism of these agencies must be verified, no government agency currently has executive authority in this area. Because genetic disorders often require huge expenditures to help patients live with dementia, health insurance is necessary. As Taiwan currently offers universal healthcare under the National Health Insurance program, dementia is currently and will continue to be an immense challenge to both the government and the nursing profession. Currently, medical knowledge related to genetic diseases and the ability of health professionals to provide effective treatments are still very limited. The nursing profession should be aware of the trends and challenges related to genetic disorders and devise appropriate policies in order to response the challenges.

Health-care access among adults with epilepsy: The U.S. National Health Interview Survey, 2010 and 2013.

INTRODUCTION: Community-based and other epidemiologic studies within the United States have identified substantial disparities in health care among adults with epilepsy. However, few data analyses addressing their health-care access are representative of the entire United States. This study aimed to examine national survey data about adults with epilepsy and to identify barriers to their health care. MATERIALS AND METHODS: We analyzed data from U.S. adults in the 2010 and the 2013 National Health Interview Surveys, multistage probability samples with supplemental questions on epilepsy. We defined active epilepsy as a history of physician-diagnosed epilepsy either currently under treatment or accompanied by seizures during the preceding year. We employed SAS-callable SUDAAN software to obtain weighted estimates of population proportions and rate ratios (RRs) adjusted for sex, age, and race/ethnicity. RESULTS: Compared to adults reporting no history of epilepsy, adults reporting active epilepsy were significantly more likely to be insured under Medicaid (RR=3.58) and less likely to have private health insurance (RR=0.58). Adults with active epilepsy were also less likely to be employed (RR=0.53) and much more likely to report being disabled (RR=6.14). They experience greater barriers to health-care access including an inability to afford medication (RR=2.40), mental health care (RR=3.23), eyeglasses (RR=2.36), or dental care (RR=1.98) and are more likely to report transportation as a barrier to health care (RR=5.28). CONCLUSIONS: These reported substantial disparities in, and barriers to, access to health care for adults with active epilepsy are amenable to intervention.

Exaggerated male pheromones in rats may increase predation cost.

Male animals with more conspicuous visual and acoustic signals increase their mating success, but also increase the risk of being attacked by eavesdropping predators. In rodents, males with richer sex pheromones often have higher attractiveness to females, but whether or not the males are also at higher predation risk is poorly known. Here, we used 2 laboratory inbred strains of the rat Rattus norvegicus, Brown Norway (BN) and Lewis (LEW), and wild-captured rats as odor donors to assess the relationship between the pheromone levels in male rats and attractiveness to domestic cats Felis catus. LEW rats had significantly higher levels of male pheromones (e.g., 4-heptanone, 2-heptanone, and 9-hydroxy-2-nonanone) than BN rats. Simultaneously, wild-captured male rats were selectively assigned to 2 groups (HIGH or LOW) based on pheromone content as determined by gas chromatography-mass spectrometry (GC-MS). Binary choice tests were carried out during the night in the test room. We found that cats spent more time investigating male bedding and urine of LEW rats than the counterpart of BN rats. Likewise, cats also preferred bedding and urine odor of the HIGH wild rats compared with the counterparts of LOW wild rats. Adding synthetic analogs of the 3 pheromone ketones into the urine of either BN rats or LOW wild rats significantly increased their attractiveness to cats. Our data suggest that the rats with exaggerated male pheromones more strongly attracted predators and thus as a consequence may suffer from elevated predation risk.

Prevalence of bilateral Discoid Lateral Menisci (DLM) in patients operated for symptomatic DLM with a follow-up study on their asymptomatic contralateral knees: a Magnetic Resonance Imaging (MRI) assessment.

BACKGROUND: The purpose was to investigate prevalence of bilateral discoid lateral menisci (DLM) in Han Chinese patients who received surgery for symptomatic DLM, as well as a follow-up study of their asymptomatic contralateral knees using magnetic resonance imaging (MRI). METHODS: A total of 110 patients [50 males and 60 females; average age: 21.95 ± 12.77 years (range: 6 to 67 years)] admitted to our hospital with symptomatic DLM were treated with arthroscopic surgery. The contralateral asymptomatic knees were evaluated for DLM by MRI. Postoperative clinical evaluation was performed using the Lysholm knee scoring scale and International Knee Documentation Committee subjective knee evaluation. RESULTS: Eighty (72.73%) of 110 symptomatic DLM patients had bilateral DLM, of which 68 (85%) were of homotype (same type). Fourteen of 80 bilateral DLM patients were symptomatic and received operations in both knees. Twelve of remaining 66 bilateral DLM patients with asymptomatic one knee underwent a second arthroscopic surgery as their asymptomatic knees became symptomatic over the five-year interim. Of these 12 cases, seven exhibited no shift and five showed posterocentral meniscal shift. Furthermore, at least two cases showed progression from asymptomatic grade II to symptomatic grade III over the interim. All patients showed significant improvement after surgery. CONCLUSIONS: The bilateral DLM rate of Han Chinese patients with symptomatic DLM was relatively high at 72.7 %, and 85 % of those were of homotype.

A novel method of terahertz spectroscopy and imaging in reflection geometry.

In reflection geometry of terahertz spectroscopy, the biological sample is usually placed on a sample window. This paper presents a novel method for eliminating the effect of the ringing, i.e., the interference between reflections of the reference and the sample, and from the air-window and sample-window interfaces, respectively. In the proposed method, a special thickness of substrate is designed to acquire an accurate reference reflection. The reflections of the samples of deionized water and ethanol were examined, and the calculation of optical properties of the samples by using our proposed method agrees with standard data. The main advantages of this method are simplicity, accuracy, and ease of application for reflection systems with different incident angles.

Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001-2004.

OBJECTIVE: To estimate the prevalence of and the annual number of ambulatory health care visits for pediatric arthritis and other rheumatologic conditions. METHODS: We used physician office visit, outpatient department visit, and emergency department visit data from the 2001-2004 National Ambulatory Medical Care Survey and 2001-2004 National Hospital Ambulatory Medical Care Survey to estimate annual visits for the International Classification of Diseases, Ninth Revision, Clinical Modification codes thought to represent significant pediatric arthritis and other rheumatologic conditions (SPARC). We converted visit estimates into prevalence estimates using data on the number of prior annual visits per patient. Synthetic estimates for states were produced using national rates. RESULTS: The average annualized estimate of the number of children with SPARC was 294,000 (95% confidence interval [95% CI] 188,000-400,000). The annualized number of ambulatory health care visits for SPARC was 827,000 (95% CI 609,000-1,044,000). CONCLUSION: Pediatric arthritis estimates have varied widely because it is an umbrella term for which there are many definitions and because it is a relatively uncommon condition from a population surveillance perspective. Our estimates suggest that arthritis-related health care visits impose a substantial burden on the pediatric health care system. One advantage of this surveillance paradigm is that it has established a starting point for tracking the national prevalence of arthritis and rheumatologic conditions in children on an ongoing basis using existing infrastructure rather than expensive new surveys. This surveillance system will help us monitor and predict the health care needs of patients with these conditions.

Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents.

OBJECTIVES: The present study aims to evaluate the accuracy of the index of waist-to-height ratio (WHTR), and proposed the optimal thresholds of WHTR in the definition of childhood overweight and obesity in a bi-ethnic Chinese school-aged population. RESEARCH METHODS AND PROCEDURES: Overweight and obese were identified by BMI for age and gender in a random sample including 2055 Han and 2132 Uygur ethnic school-aged children (8 to 18 years old). WHTR was calculated by waist circumference divided by height on the basis of standard anthropometric measurements. Receiver operating characteristic (ROC) curve analyses were performed to assess the accuracy of WHTR as a diagnostic test for childhood overweight and obesity, compared with waist circumference. The optimal thresholds of WHTR for defining overweight and obesity were recommended respectively by gender. The correlation between WHTR and age was analyzed and compared with BMI. RESULTS: A-values (area under curve) of WHTR for diagnosing overweight and obesity were both over 0.90 in both genders and better than those of waist circumference. A threshold of 0.445 was identified for overweight in both genders, with the sensitivity and specificity >0.80. The thresholds for defining obesity was 0.485 in boys and 0.475 in girls, both having the sensitivity and specificity >0.90. WHTR showed less association with age than BMI. CONCLUSIONS: WHTR is a simple, easy, accurate, and non-age-dependent index with high applicability to screening overweight and obesity in children and adolescents. The use of WHTR in the general childhood population has been justified by this study.