The Effect of Nursing Internships on the Effectiveness of Implementing Information Technology Teaching.

In nursing education, the diversity of clinical scenarios is complex and dynamic, and it is a challenge for nursing students to learn this clinical knowledge in conventional teaching mechanisms. However, integrating information technology into teaching can promote diversity of learning environment. This study aimed to investigate the effectiveness of teaching mechanisms which combined clinical simulation scenario and Information Technology Integrated Instruction. This study applied innovative experimental teaching in medical-surgical and critical care nursing courses for nursing students in their fourth or fifth year at a five-year junior college. Instructional systems design was combined with clinical simulation scenarios and technology to develop multidimensional teaching strategies. Fifth-year students' overall OSCE mean score was considerably higher than that of fourth-year students; specifically, their scores on basic life support and care for subdural hemorrhage varied substantially. Compared with fourth-year students, fifth-year students performed considerably greater on situational awareness. The results of the present study can be used to develop nursing core competencies and improve the clinical care competency of nursing personnel.

Effectiveness of applying clinical simulation scenarios and integrating information technology in medical-surgical nursing and critical nursing courses.

BACKGROUND: To determine the impact of combining clinical simulation scenario training and Information Technology Integrated Instruction (ITII) on the teaching of nursing skills. METHODS: 120 4th-year students in a nursing program who were enrolled in medical and surgical nursing courses. 61 received innovative instruction (experimental group) and 59 received conventional instruction (control group). The ADDIE model, systematic method of course development that includes analysis, design, development, implementation, and evaluation,was used to build simulation teaching and clinical scenarios and to create and modify objective structure clinical examination (OSCE) scenario checklists for acute myocardial infarction (AMI) care, basic life support and operation of automated external defibrillator (BLS), and subdural hemorrhage (SDH) care. The modified OSCE checklists were assessed for reliability, consistency, and validity. The innovative training included flipped classrooms, clinical simulation scenarios, ITII and blended learning formats. RESULTS: The reliability and validity of the OSCE checklists developed in this study were acceptable and comparable or higher than checklists in past studies and could be utilized as an OSCE performance tool. Students in innovative instruction obtained significantly better OSCE performance, lab scores and improvements from the previous year's grades. Significant differences were found in situational awareness (SA). No strong correlations were found between OSCE scores and clinical internship scores, and no significant differences were found between the groups in overall clinical internship performance. CONCLUSIONS: Innovative instruction showed better performance than conventional methods in summative evaluation of knowledge components, OSCE formative evaluation and clinical nursing internship scores, as well as improved situational awareness in nursing students.

Effects of different takeover request interfaces on takeover behavior and performance during conditionally automated driving.

Automated driving is a developing trend that is coming to the consumer market, and conditionally automated driving (CAD) is anticipated to become the primary automated driving system. For enhancing both the comfort and security of human drivers in self-driving cars, the most significant concern of CAD is ensuring that not only can the driver conduct non-driving related tasks (NDRT) while automated driving is in progress, but also quickly and competently take over when the system reaches a limit and issues a takeover request (TOR). However, the level of distraction by NDRTs may affect the transition from automated driving to the human driver taking over. The focus of the present study was allowing a driver immersed in NDRTs to discover the TOR and take control of the driving quickly. A 3×2×2 factor experimental design was used: vehicle display interface information load (basic vs. prediction vs. advanced prediction interfaces); TOR information load (directional vs. non-directional information notifications); and degree of NDRT immersion (not performing vs. performing an NDRT when TOR prompt was issued). 48 participants were recruited, and different automotive display interfaces were used as TOR prompts with different information loads during driving to analyze the takeover behavior, performance, and subjective perception of the drivers, who were immersed in a smartphone-related task. The takeover process out of NDRT immersion was found to be more efficient with the advanced prediction interface, compared to the other two interfaces. All groups achieved faster takeovers and demonstrated better takeover performance if given directional rather than non-directional information, regardless of interface type or NDRT immersion.

Postural Control and Functional Ankle Stability in Professional and Amateur Skateboarders.

Basic maneuvers in skateboarding, such as the ollie, put the player at high risk for ankle injuries because of the position of the feet required to perform the maneuvers. This study investigated ankle stability and reaction time for the tibialis anterior, fibularis longus, and fibularis brevis in professional and amateur skateboarders. In total, 16 professional and 16 amateur skateboarders were recruited as participants and underwent range of motion assessments, balance testing, and muscle reaction time measurements. The results revealed that professional skateboarders had a significantly smaller inversion angle compared to amateur players, which suggested better joint control and hence greater safety in the former. Balance testing results indicated better balance in professional skateboarders, and healthy skateboarders had better balance than did injured professional and amateur skateboarders. No significant difference in muscle reaction time was observed between amateur and professional skateboarders.

Relationship between Musculoskeletal Disorders and Work Performance of Nursing Staff: A Comparison of Hospital Nursing Departments.

This study aimed to explore the relationship between musculoskeletal disorders and the work performance of nursing staff. This cross-sectional study used the Checklist for Musculoskeletal Disorders (MSDs), the Nordic Musculoskeletal Questionnaire (NMQ), and the Work Ability Index to survey the prevalence of MSDs, as well as to determine the impact of MSDs on 117 nursing staff working in an emergency department, an intensive care unit, and general wards. The findings indicate that the nursing staff were exposed to a workplace environment with a high risk of MSDs. Nursing staff in the emergency department were at a particularly high risk of MSDs in their upper and lower limbs, while those working in the intensive care unit had a particularly high risk of injuries caused by manual material handling. Analyzing the relationship between MSD risk factors and NMQ scores showed a 6 times, 3.25 times, and 2.28 times increase in MSD conditions with a high workload compared to a low workload in the hand and wrist, the lower back or waist, and the knee, respectively. Medium and high workloads were found to increase the risk of MSD, which in turn affected the work ability of the nurses.

Minimal contribution of IP3R2 in cardiac differentiation and derived ventricular-like myocytes from human embryonic stem cells.

Type 2 inositol 1,4,5-trisphosphate receptor (IP3R2) regulates the intracellular Ca2+ release from endoplasmic reticulum in human embryonic stem cells (hESCs), cardiovascular progenitor cells (CVPCs), and mammalian cardiomyocytes. However, the role of IP3R2 in human cardiac development is unknown and its function in mammalian cardiomyocytes is controversial. hESC-derived cardiomyocytes have unique merits in disease modeling, cell therapy, and drug screening. Therefore, understanding the role of IP3R2 in the generation and function of human cardiomyocytes would be valuable for the application of hESC-derived cardiomyocytes. In the current study, we investigated the role of IP3R2 in the differentiation of hESCs to cardiomyocytes and in the hESC-derived cardiomyocytes. By using IP3R2 knockout (IP3R2KO) hESCs, we showed that IP3R2KO did not affect the self-renewal of hESCs as well as the differentiation ability of hESCs into CVPCs and cardiomyocytes. Furthermore, we demonstrated the ventricular-like myocyte characteristics of hESC-derived cardiomyocytes. Under the α1-adrenergic stimulation by phenylephrine (10 µmol/L), the amplitude and maximum rate of depolarization of action potential (AP) were slightly affected in the IP3R2KO hESC-derived cardiomyocytes at differentiation day 90, whereas the other parameters of APs and the Ca2+ transients did not show significant changes compared with these in the wide-type ones. These results demonstrate that IP3R2 has minimal contribution to the differentiation and function of human cardiomyocytes derived from hESCs, thus provide the new knowledge to the function of IP3R2 in the generation of human cardiac lineage cells and in the early cardiomyocytes.

Design and Development of a Wearable Exoskeleton System for Stroke Rehabilitation.

For more than a decade, many countries have been actively developing robotic assistive devices to assist in the rehabilitation of individuals with limb disability to regain function in the extremities. The exoskeleton assistive device in this study has been designed primarily for hemiplegic stroke patients to aid in the extension of fingers to open up the palm to simulate the effects of rehabilitation. This exoskeleton was designed as an anterior-support type to achieve palmar extension and acts as a robotic assistive device for rehabilitation in bilateral upper limb task training. Testing results show that this wearable exoskeleton assistive device with human factor consideration using percentile dimensions can provide comfortable wear on patients as well as adequate torque to pull individual fingers into flexion towards the palm for rehabilitation. We hope this exoskeleton device can help stroke patients with loss of function in the upper extremities to resume motor activities in order to maintain activities of daily living.

A Clinical Trial of the Effect of a Blood Leakage Detection Device for Patients during Hemodialysis.

In hemodialysis, vascular access is usually achieved through an arteriovenous fistula, and a dislodged needle can cause varying degrees of injury to patients. In severe cases, the loss of blood can prove to be fatal. This study proposed a blood leakage detection device for patients during hemodialysis (HD). First, the device was tested on a phantom arm, and later in a clinical test on patients receiving HD. The thoughts of the patients and the nursing staff involved were surveyed before and after the introduction of the device. Analysis of the results indicated that the device achieved 100% and 98.9% accuracy rates on the phantom arm test and clinical test, respectively. The results suggested that patients believed the device could reduce their mental anxiety, and the nursing staff considered the device reliable and that it would enhance the quality of care. The proposed detection device can be extended to similar applications for preventing catheter dislodgement, and to improve patient safety and reduce the stress of clinical nursing staff.

Differences in road-crossing decisions between healthy older adults and patients with Alzheimer's disease.

INTRODUCTION: This study investigated the differences in road-crossing behavior among healthy older adults and patients with Alzheimer's disease (AD). METHOD: Twelve pedestrians with mild AD and 24 age-, gender-, and education-matched controls were examined with a battery of cognitive, visual, and motor tests. Using a simulated two-lane, one-way road-crossing situation, we determined the remaining time and safety margin for each participant in traffic situations involving different vehicle speeds (40 km/h vs. 60 km/h vs. 80 km/h), time gaps (5 s vs. 7 s vs. 9 s), and time of day (dusk vs. midday). RESULTS: We found that patients with AD were more vulnerable to traffic crash while crossing the road than healthy older adults (Odds Ratio = 2.50, P < 0.05). Compared with healthy older adults, patients with AD were more severely affected by daylight conditions, faster vehicle speed, and shorter time gap. Participants in both groups had a significantly higher risk of unsafe crossing behavior if they had lower scores on the Mini-Mental State Examination (MMSE), Complex Figure Test - recall (CFT-Recall), Trail Making Test (TMT) B-A, Useful Field of View (UFOV) - total, and Visual Form Discrimination (VFD). We also found that when given a long enough time gap (9 s), patients with AD and healthy older adults used similar safe road-crossing behaviors, independent of other factors. PRACTICAL APPLICATIONS: These results provide important suggestions for road design for patients with AD and healthy older adults during road-crossing.

Combined image enhancement, feature extraction, and classification protocol to improve detection and diagnosis of rotator-cuff tears on MR imaging.

PURPOSE: The diagnosis of most rotator cuff tears (RCTs) relies upon magnetic resonance (MR) imaging, but direct capture of MR images without enhanced image processing leads to poor image contrast and potential misdiagnosis. Therefore, we developed a 2-stage model for the detection and diagnosis of injury of the supraspinatus tendon. METHODS: The first stage used coupled weighted histogram separation (WHS) to improve image enhancement, and the second stage extracted suspicious texture, features of both spatial and spectral domains, and sequential floating forward selection (SFFS) selected features conducive to classification of RCTs. We then tested injuries of the supraspinatus tendon using the classifier. RESULTS: The extraction of features by SFFS can increase detection of supraspinatus injury by reducing the input vector by 57.78% from the enhanced input images. The receiver operating characteristic (ROC) curve indicated an azimuth (Az) value of 84.38% when SFFS selected 76 features to construct a support vector machine (SVM) classifier from the enhanced images, compared with 56.94% when all 180 features from the raw input images were used for the construction. CONCLUSIONS: The performance of the classifier constructed by SFFS-selected features is superior to that using all features. These findings can serve as references to improve diagnosis and treatment of supraspinatus injuries.

Predictors of road crossing safety in pedestrians with Parkinson's disease.

Road-crossing safety is an important issue in an aging society. Information regarding the risk of crossing the street to pedestrians with Parkinson's disease (PD) is limited. To assess the risk and predictors of unsafe crossing behaviors in patients with PD, we compared 31 pedestrians with mild-to-moderate PD to 50 age/gender/education-matched controls using a battery of cognitive, visual, and motor tests. With a simulated simple street-crossing situation, we determined the remaining time and safety margin for each participant in different traffic situations, including variable motor vehicle speed, time gap, and time of the day. Odds ratios (ORs) were estimated by logistic regression models. We found that pedestrians with PD were more vulnerable to traffic accidents than controls (OR 1.61 [1.28-2.02], P=0.01). The risk of crossing road correlated in a dose-dependent manner with the severity of PD, based on both Hoehn and Yahr (H&Y) stages and unified Parkinson's disease rating scale (UPDRS) motor scores (OR 1.13 for each increasing point of UPDSR, P<0.01). Among PD patients, scores of clock drawing test (OR 0.8 [0.74-0.88], P<0.01) and visual form discrimination (OR 1.14 [1.07-1.22], P<0.01) predicted worsening of safety errors, rather than executive function. Environmental factors, such as fast approaching motor vehicle speed (OR 4.50 [2.92-6.95], P<0.01), short time gap (OR 45.98 [27.04-78.18], P<0.01), and time of day (OR 4.45 [3.11-6.36], P<0.01) also affected road-crossing safety. Future large sample studies are needed to confirm our findings. Training programs or portable stimulator devices that compensate for the visual-spatial disabilities of PD patients are required to improve road safety for PD patients.

Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures.

OBJECTIVES: Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survival of patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis. METHODS: An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed. RESULTS: Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty. CONCLUSIONS: Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.

Effects of age and the use of hands-free cellular phones on driving behavior and task performance.

OBJECTIVE: This study used a driving simulator to investigate the effect of using a Bluetooth hands-free cellular phone earpiece on the driving behavior of two age groups. METHODS: Forty-eight participants (24 aged 20-26 and 24 aged 65-73) were examined to assess their performance on the following divided-attention tasks under 2 driving load conditions (high and low): (1) attempting to maintain the speed limit and (2) using a cellular phone while driving. The length of the call conversation (long vs. short) and the conversational content (complex vs. simple) were manipulated as within-subject independent variables. The driving behavior of the participants, their task reaction times and accuracy, and subjective ratings were collected as dependent variables. RESULTS: The results indicate that under low driving loads, short talk times, and simple conversational content, the driving behavior of the participants showed low variance in the vehicle's mean speed. In contrast, complex conversation had a significantly negative impact on driving behavior. Notably, under a low driving load, motorists' driving behaviors, measured in lateral acceleration, caused significantly smaller variance in complex conversations compared to no call and simple conversations. The use of a hands-free cellular phone affected the performance (acceleration, lane deviation, reaction time, and accuracy) of older drivers significantly more than younger drivers. While performing divided attention tasks, the accuracy of the older drivers was 66.3 percent and that of the younger drivers was 96.3 percent. Although this study did not find a clear impact of cellular phone use on the driving behavior of younger drivers, their divided-attention task reaction times and accuracy were better under no-call than calling conditions. CONCLUSIONS: This study indicates that the use of hands-free cellular phones could significantly affect the safety of driving among the older and present risks, although lesser, for younger drivers.

Comparison of artificial neural network and logistic regression models for predicting mortality in elderly patients with hip fracture.

PURPOSE: Older patients with hip fracture have a mortality rate one year after surgery of 20-30%. The purpose of this study is to establish a predictive model to assess the outcome of surgical treatment in older patients with hip fracture. METHODS: A database of information from 286 consecutive cases of surgery for hip fracture from the Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, was utilised for model building and testing. Both logistic regression and artificial neural network (ANN) models were developed. Cases were randomly assigned to training and testing datasets. A testing dataset was utilised to test the accuracy of both models (n=89). RESULTS: The areas under the receiver operator characteristic curves of both models were utilised to compare predictability and accuracy. The logistic regression training and testing datasets had an area of 0.938 (95% CI: 0.904, 0.972) and 0.784 (95% CI: 0.669, 0.899), respectively, below the 0.998 (95% CI: 0.995, 1.000) and 0.949 (95% CI: 0.857, 1.000) of the final ANN model. CONCLUSION: Overall, ANNs have higher predictive ability than logistic regression, perhaps because they are not affected by interactions between factors. They may assist in complex decision making in the clinical setting.

Ca2+ sparks and Ca2+ glows in superior cervical ganglion neurons.

AIM: Ca2+ release from the endoplasmic reticulum (ER) is an integral component of neuronal Ca2+ signaling. The present study is to investigate properties of local Ca2+ release events in superior cervical ganglion (SCG) neurons. METHODS: Primary cultured SCG neurons were prepared from neonatal rats (P3-P7). Low concentration of caffeine was used to induce Ca2+ release from the ER Ca2+ store, and intracellular Ca2+ was recorded by high-resolution line scan confocal imaging and the Ca2+ indicator Fluo-4. RESULTS: Two populations of local Ca2+ release events with distinct temporal characteristics were evoked by 1.5 mmol/L caffeine near the surface membrane in the soma and the neurites of SCG neurons. Brief events similar to classic Ca2+ sparks lasted a few hundreds of milliseconds, whereas long-lasting events displayed duration up to tens of seconds. Typical somatic and neurite sparks were of 0.3- and 0.52-fold increase in local Fluo-4 fluorescence, respectively. Typical Ca2+ glows were brighter (deltaF/F0 approximately 0.6), but were highly confined in space. The half maximum of full duration of neurite sparks was much longer than those in the soma (685 vs 381 ms). CONCLUSION: Co-existence of Ca2+ sparks and Ca2+ glows in SCG neurons indicates distinctive local regulation of Ca2+ release kinetics. The local Ca2+ signals of variable, site-specific temporal length may bear important implications in encoding a 'memory' of the trigger signal.