[Interprofessional knowledge and skills training of the insertion technique for the PEG placement on simulators - development and testing of a national curriculum for physicians and nurses]. / Interprofessionelles Wissens- und Skillstraining der PEG-Anlage an Simulatoren ­ Entwicklung und Testung eines nationalen Curriculums für Ärzte und spezialisierte Pflegende.

INTRODUCTION: Expert opinion within the field of gastroenterology mandates a national training curriculum to be completed prior to performing a percutaneous endoscopic gastrostomy (PEG).The goal of the present study is both the development and evaluation of such a curriculum, thus aiming to provide physicians and nurses with the necessary knowledge and skills to safely perform the PEG procedure. METHODS: Testing was performed using a non-randomized, interventional pilot study on simulators. This included a: (1) preparatory, (2) theoretical, and (3) practical phase. Following the theoretical phase, cognitive skills were assessed with a knowledge test. During the practical phase, each participant's puncture procedure was recorded with a multi-channel video, and sensorimotor skills were evaluated with an assessment instrument (AS-PEG). Finally, participant satisfaction was evaluated using a questionnaire. RESULTS: Seven physicians and 17 nurses completed all phases and final examinations, as defined in the curriculum. An average of 70.3 ±â€Š3.7 (61-75) of 76 points and 37.1 ±â€Š2.1 (32-40) of 42 points were achieved in the knowledge and acquired sensorimotor skills tests, respectively. Overall, the evaluation revealed a high level of satisfaction among the participants with respect to content, achievement of learning objectives, and acquired practical skills. CONCLUSION: Dissemination of the curriculum is deemed useful and necessary to provide the theoretical and practical knowledge for physicians and nurses through a structured inter-professional knowledge and skills-training format and to offer nurses a legally secure framework.

[Comparison of safety insertion techniques of percutaneous endoscopic gastrostomy in nurses and physicians - a non-randomized interventional pilot study on a simulation model]. / Vergleich der Sicherheit der perkutan gastralen Punktion im Rahmen der PEG-Anlage zwischen Ärzten und spezialisierten Pflegenden ­ eine nicht randomisierte, interventionelle Pilotstudie an Simulatoren.

Percutaneous endoscopic gastrostomy (PEG) insertion represents a standardized procedure for enteral nutrition in patients with long-term eating difficulties for various reasons. In a clinical setting, delegation of stomach puncture and placement of a PEG tube, within the context of percutaneous endoscopic gastrostomy amongst nurses, occurs. In Germany, there are no studies yet showing the differences between physicians and nurses regarding the safety of percutaneous stomach puncture.In a non-randomized quasi-experimental interventional study on a simulation model, the safety of stomach puncture within the context of percutaneous endoscopic gastrostomy between physicians and nurses with special training was compared. Technical skills were recorded with video cameras and provided the basis for the following analysis. The study contained: (1) a theoretical preparation phase, (2) training on simulation model and a repeated practice of the skills, and (3) stomach puncture on the simulation model. The actions were recorded with a multichannel video technique. As part of the concept, nurses and physicians were trained together in theory and practice. The analysis was conducted with the newly designed Assessment Instrument Percutaneous Endoscopic Gastrostomy (AS-PEG). Seven physicians and 17 nurses took part in the pilot study. On average, the physicians reached a score of 36.4 ±â€Š2.2 (33 - 39) and nurses 37.4 ±â€Š2 (32 - 40), while the maximum score was 42. The evaluation of technical skills on the recorded videos by means of Assessment Instrument Percutaneous Endoscopic Gastrostomy (AS-PEG) showed no tendency to significant differences between physicians and nurses after theoretical and practical training. The study contributes a first objective evaluation of technical skills on stomach puncture within the context of percutaneous endoscopic gastrostomy with the newly designed AS-PEG.

Two types of redundancy in multimedia learning: a literature review.

Regarding the redundancy effect in multimedia learning environments, more consistency is needed in the theoretical assumptions and investigation of this effect. Current research lacks a comprehensive account of different redundant scenarios in which materials facilitate or inhibit learning and provides little conceptual guidance on how learning processes are affected by different types of redundancy. Theoretical assumptions refer to redundancy as a contentual overlap of information provided by the learning material; in this case, processing duplicated information strains the learners' limited cognitive capacities. Other assumptions refer to the role of processing limitations in working memory channels, including separate processing for visual and verbal information. In this case, an ineffective combination of sources leads to an overload of the limited working memory capacity. This paper reviews empirical research on the redundancy effect (63 studies) and classifies two types of redundancy: (1) content redundancy, and (2) working memory channel redundancy. From an instructional psychology perspective, the analyses reveal four different implementations of redundant scenarios: (1) adding narration to visualizations, (2) adding written text to visualizations, (3) adding written text to narration, and (4) adding written text to narrated visualizations. Regarding the effects of the two redundancy types within these scenarios, analyses indicate positive effects of content redundancy (affected by learners' prior knowledge), negative effects of working memory channel redundancy (regarding visualizations and written text), and positive effects of working memory channel redundancy (regarding narration and written text). Moreover, results point to factors that might moderate the effect of redundancy and illustrate interactions with existing multimedia effects. Overall, this review provides an overview of the state of empirical research and reveals that the consideration of both redundancy types provides further explanations in this field of research.

Different types of redundancy and their effect on learning and cognitive load.

BACKGROUND: What is redundancy? While most studies confirm that redundancy is harmful to learning, there are two theoretical approaches to redundancy. The first understands redundancy as a contentual overlap that puts demand on the limited cognitive capacities of the learner. The second understands redundancy as an ineffective combination of sources leading to an overload of the limited working memory modalities. AIMS: Since these theoretical differences are rarely acknowledged in operation, this study proposes a classification of two distinct types of redundancy to compare these experimentally to investigate their possible main and interaction effects. The first type, content redundancy, is concerned with the contentual overlap of information. The second type, modal redundancy, is concerned with the modalities in which the information is displayed. METHODS: We used these two types of redundancy as factors in a 2 × 2 within-subject design, in which we experimentally compared their effects. SAMPLE: University students (N = 46) learned from specifically designed domain-general material which aimed to observe redundancy effects without interference from confounding variables. RESULTS: The results show that content redundancy increases learning outcomes and decreases cognitive load, while modal redundancy decreases learning outcomes and increases cognitive load. CONCLUSION: On the theoretical level, these findings confirm the usefulness to distinguish content redundancy from modal redundancy. On the practical level, the empirical findings of the different effects of the two types of redundancy provide educators with important insights that can improve the design of multimedia learning materials.

Mindsets and Self-Concepts About Self-Regulated Learning: Their Relationships With Emotions, Strategy Knowledge, and Academic Achievement.

Being a self-regulated learner and believing that deliberate strategy use might be an effective way of overcoming learning challenges is important for achieving academic success. Learners' self-theories about their abilities might explain why some students are more inclined to engage in self-regulated learning (SRL) than others. This study aims to investigate the relationships between students' mindsets and self-concepts about SRL and their correlation with enjoyment, boredom, strategy knowledge, and academic achievements. As covariates, we included gender, age, and academic track. We surveyed 244 students (46.3% female) from the lower secondary school level with a mean age of 14.57 years. The results revealed that mindsets about SRL support more adaptive learning emotions (i.e., higher enjoyment and lower boredom) and positively relate to students' strategy knowledge. The students' self-concepts about SRL are positively related to their enjoyment and academic achievements. Gender-specific differences between the students revealed a disadvantage for the boys, who had lower self-concepts about SRL, lower strategy knowledge, and lower academic achievements in comparison to the girls. Furthermore, the study also revealed that students in the lower academic track adhered more to a fixed mindset about SRL and had lower strategy knowledge than their peers in the higher academic track. Finally, we found an indirect relationship between mindset about SRL and academic achievement via self-concepts about SRL. Overall, our results emphasize the importance of students' mindsets and self-concepts about SRL for their learning and academic achievements.

Development and Pilot Validation of an Instrument Assessing Sensorimotor Skills for Percutaneous Gastral Puncture.

INTRODUCTION: The acquisition of sensorimotor skills, so-called "technical skills", plays an essential part in the professional and continuing educational training of medical and nursing staff. Facilities turn to simulator training to promote the safe and accurate performance of endoscopic examinations. Thus, this study aimed to develop and pilot-test a corresponding assessment instrument to monitor necessary sensorimotor or "technical" skills of the examiner for a safe percutaneous endoscopic gastrostomy (AS-PEG). MATERIALS AND METHODS: Instrument development and pilot validation involved four stages: identification of potential items and initial draft of the AS-PEG; expert panel with 11 experts (content validity index [CVI] calculated); empirical validation using a quasi-experimental intervention on simulators; revision of the pilot AS-PEG taking expert assessment, and empirical testing into consideration. RESULTS: The initial instrument yielded 13 categories and 44 items describing the PEG procedure. Experts rated 30 out of 44 items (68%) extremely or very important for the safety of the puncture of the stomach. Initial item-CVIs ranged from 0.00 to 1.00; scale-CVI was 0.61. Twenty-four trainees (7 physicians, 17 nurses) participated in the pilot simulation study. On average, 8:25 min were required for PEG placement (min-max 5:59-13:38 min, SD = 1:43). The revised AS-PEG version was reduced to 14 items with a range of the item CVI from 0.8 to 1.0, and a scale-CVI of 0.90. CONCLUSION: The AS-PEG instrument facilitates the evaluation of sensorimotor skills during percutaneous gastric puncture procedures within the context of PEG placement, across professions and without relating to the number of procedures previously performed. The instrument is economical and shows satisfying content validity.

A longitudinal study of teachers' occupational well-being: Applying the job demands-resources model.

The job demands-resources model (JD-R model; Bakker & Demerouti, 2014) is well established in occupational research, and the proposed processes it posits have been replicated numerous times. Thus, the JD-R model provides an excellent framework for explaining the occupational well-being of beginning teachers-an occupation associated with particularly high levels of strain and consequently, high attrition rates. However, the model's assumptions have to date mostly been tested piecewise, and seldom on the basis of longitudinal models. With a series of longitudinal autoregressive SEM models (N = 1,700) we tested all assumptions of the JD-R model simultaneously in one model with an applied focus on beginning teachers. We assessed self-reports of beginning teachers at three time waves: at the beginning and end (one and a half to two years later) of their preservice period, and again, one year later. Results revealed significant direct effects of resources (self-efficacy) on engagement, of demands (classroom disturbances) on strain (emotional exhaustion), and a significant reverse path of engagement on self-efficacy. Additionally, the results showed two moderation effects: Self-efficacy buffered the demands-strain relationship, while self-efficacy also predicted engagement, especially when disturbances were high. Thus, self-efficacy in classroom management plays an important role in the teachers' stress development process, as it will, in case of high classroom disturbances, not only buffer the strain-enhancing effects, but also boost engagement. Commitment was predicted directly by emotional exhaustion and engagement, but indirectly only by self-efficacy (via engagement). Thus, we provide strong empirical support for the JD-R model. (PsycINFO Database Record

Aortic remodelling in aortic dissection after frozen elephant trunk†.

OBJECTIVES: Frozen elephant trunk (FET) can be used for continuous downstream aorta treatment in acute aortic dissection (AAD) and chronic aortic dissection (CAD). The study reports the changes in the lumen volumes along the downstream aorta towards remodelling. METHODS: In 70 patients (22 CAD, 48 AAD), pre-, postoperative and at least the 1-year follow-up aortic imaging was available. Volume changes of aortic lumen (AL) and true lumen (TL) between examinations along the stent graft aortic segment (A), downstream to coeliac trunk (B) and distally to bifurcation (C) were used for quantification. TL increase >10% with stable AL or AL decrease >10% with stable TL were classified as positive, changes within a 10% threshold as stable, and all other changes as negative remodelling. RESULTS: In AAD, positive or stable remodelling occurred in A (90%), B (65%), C (58%) within 1 year, thereafter in 26 patients (follow-up: 47 ± 21 months) in A (92%), B (65%), C (62%). Negative remodelling in ≥2 segments was found in 5/26 (19%) patients. In CAD, positive or stable remodelling occurred in A (100%), B (86%), C (77%) within 1 year, thereafter in 16 patients (follow-up: 46 ± 20 months) in A (75%), B (44%), C (38%). Negative remodelling in ≥2 segments was found in 7/16 (43%) patients, 5 underwent reintervention, and stabilized thereafter. CONCLUSIONS: FET facilitates positive remodelling in AAD and CAD down to stent graft level. Distally, 20% AAD and 40% CAD patients remain at risk for secondary reintervention, and can be identified by negative remodelling in ≥2 segments in the follow-up examinations.

Comparison of ascending aortic cohesion between patients with bicuspid aortic valve stenosis and regurgitation.

OBJECTIVES: A bicuspid aortic valve (BAV) is commonly associated with aortic wall abnormalities, including dilatation of the ascending aorta and increased potential for aortic dissection. We compared the mechanical properties of the aortic wall of BAV patients with aortic valve stenosis (AS) and regurgitation (AR) using a dissectometer, a device mimicking transverse aortic wall shear stress. METHODS: Between March 2010 and February 2013, 85 consecutive patients with bicuspid aortic valve undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with stenosis (Group 1, n = 58) or regurgitation (Group 2, n = 27). Aortic wall cohesion measured by the dissectometer (Parameters P7, P8 and P9), aortic diameters measured by transoesophageal echocardiography (TOE) and thickness of the wall were compared. One patient presenting with the Marfan syndrome was excluded from the study. RESULTS: Patients with aortic regurgitation were significantly younger (48.2 ± 15.8 vs 64.7 ± 10.7, P < 0.001), and had a significantly thicker aortic wall (2.30 ± 0.49 mm vs 2.06 ± 0.35 mm, P = 0.029). Transoesophageal echocardiography diameters (annulus, aortic sinuses and sinotubular junction) were significantly larger in the AR group (27.3 ± 3.6 vs 25.5 ± 2.4, P = 0.008; 41.1 ± 7.7 vs 36.7 ± 8.0, P = 0.011; 37.6 ± 9.7 vs 33.8 ± 9.1, P = 0.049). The ascending aortic diameter did not differ (43.2 ± 10.6 vs 40.3 ± 9.1, P = 0.292). Patients with AR had significantly worse aortic cohesion, as measured by shear stress testing (P7: 97.2 ± 45.0 vs 145.5 ± 84.9, P = 0.015; P8: 2.00 ± 0.65 vs 3.82 ± 1.56, P < 0.001; P9: 2.96 ± 0.82 vs 4.98 ± 1.80, P < 0.001) compared with those with AS. CONCLUSIONS: We observed significantly worse aortic wall cohesion, a thicker aortic wall and a larger aortic root in patients presenting with bicuspid AR compared with patients with AS. These results suggest that bicuspid AR represents a different disease process with possible involvement of the ascending aorta, as demonstrated by dissectometer examination.