[Autoimmunity accreditation: training, accreditation and maintenance of skills in indirect immunofluorescence]. / Accréditation en auto-immunité : formation, habilitation et maintien des compétences en immunofluorescence indirecte.

The ISO 15189 accreditation of biological analysis needs the validation of the analytical methods allowing the evaluation of their performance including all the factors that could influence the quality of their results. The field of autoimmunity includes many analyses and methods such as the indirect immunofluorescence technique (IIF) and the performance of this technique largely depends on the competency of staff members. For each staff member, the required levels of competency have to be precisely defined and evaluated after a period of formation before the final habilitation for the IIF technique. The French group of the international group called EASI (European autoimmunity standardisation initiative) proposes two habilitation forms to be filled with criteria, evidence and maintenance of target skills for the IIF preparation of slides and reading. These forms could be used as a model for the IIF formation and habilitation and have to be adapted to the routine practice of the laboratories.

Development and evaluation of a strength-based method to promote employment of work-disability benefit recipients with multiple problems: a feasibility study.

BACKGROUND: For people with disabilities, chances to find or keep work are negatively affected by multiple problems like lower education, poverty and poor health. Furthermore, although active labour market policies proved to be effective for unemployed in general, success rates are poor for persons who are unemployed due to multiple problems. The present study aims to describe the development of a method as well as professional training to teach its application, and to assess the feasibility of method and training. The Strength-based method (CARm) aims to promote employment of work-disability benefit recipients with multiple problems. METHODS: The main principles of the Strength model were redesigned for better applicability in a population of work-disability beneficiaries, resulting in the CARm method. As part of the CARm method, a training module for Labour Experts (LEs) was developed. To assess the new designed method and training, a one-group, pre-post design was used. Data were collected from eight participating LEs, five female and 3 male, aged between 41and 55 years and having 2-17 years working experience. We used self-report questionnaires and a semi-structured discussion meeting after the training sessions with the LEs. RESULTS: Eight labour experts (LEs) from the Dutch Social Security Institute participated in the study. Most LEs felt an improvement in their ability to ascertain developmental needs, opportunities and threats in the client's situation. Three months after the training, LEs almost unanimously agreed on the statements 'I expect to use the CARm method more frequently in the future' and 'I use the CARm method in daily practice whenever possible'. The overall rating for the training on a scale from 1 to 10 was 7.6 (range 7-9). The overall satisfaction with the trainers was good. CONCLUSIONS: The CARm method and training was found to be a feasible approach to facilitate LEs working at the UWV reintegration service to support clients with multiple problems. Sufficient managerial support for participating LEs is a key factor for successful implementation of CARm. Results show that CARm is worth testing for efficacy in a future trial.

Effectiveness of a self-management retraining program improving the quality of life of people receiving continuous ambulatory peritoneal dialysis.

People receiving continuous ambulatory peritoneal dialysis (CAPD) are often faced with technical difficulties while performing self-dialysis, which can compromise outcomes and health-related quality of life. This mixed-methods exploratory sequential study aims to implement a repeated-measures experimental design to assess the effectiveness of a self-management retraining program. The sample consisted of 41 participants living with chronic kidney disease aged 20 to 80 years who were receiving CAPD. Participants were purposively selected and randomized into experimental and control groups. The experimental group received the self-management retraining program. The control group received standard care. We compared health-related quality of life, self-management behavior, and perceived self-management self-efficacy levels at baseline and 3 and 6 months after enrollment. Participants demonstrated statistically significant increases in self-management behavior (medical adherence) and mental health status. Perceived self-efficacy in self-management was improved; however, this change did not reach statistical significance. We conclude that an self-management retraining program can improve self-management, self-efficacy behaviors, and health-related quality of life in persons receiving CAPD.

Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study.

BACKGROUND: Triage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed. METHODS: A dummy based trial on primary MCI triage with yearly follow-up after initial training using the ASAV algorithm (Amberg-Schwandorf Algorithm for Primary Triage) was undertaken. Triage was assessed concerning accuracy, sensitivity, specificity, over-triage, under-triage, time requirement, and a comprehensive performance measure. A subgroup analysis of professional paramedics was made. RESULTS: Nine hundred ninety triage procedures performed by 51 providers were analyzed. At 1 year after initial training, triage accuracy and overall performance dropped significantly. Professional paramedic's rate of correctly assigned triage categories deteriorated from 84 to 71%, and the overall performance score decreased from 95 to 90 points (maximum = 100). The observed decline in triage performance at 1 year after education made it necessary to conduct re-training. A brief didactic lecture of 45 min duration increased accuracy to 88% and the overall performance measure to 97. CONCLUSIONS: To improve disaster preparedness, triage skills should be refreshed yearly by a brief re-education of all EMS providers.

The lived experience of registered nurses educated in accelerated second degree bachelor of science in nursing programs: A hermeneutic phenomenological research study.

Accelerated Second Degree Bachelor of Science in Nursing (ASDBSN) programs have proliferated in response to the ongoing and anticipated nursing shortages of the first decades of this century. While a number of studies have reported on the students enrolled in these programs, limited information exists regarding how nurses educated in these programs experience their nursing careers beyond the first two years of practice. This study was undertaken to explore the lived experience of registered nurses educated in an ASDBSN program. Using a hermeneutical phenomenological approach, twelve ASDBSN prepared nurses with greater than 2 years in nursing practice were interviewed with five different ASDBSN programs and seven different communities in the southwest United States represented. The interviews were face to face and occurred in a setting of the participants' choice. A total of 4 themes were identified through the data analysis and a model of ASDBSN nursing practice was developed using the analogy of a river system. The themes included: Headwaters, Tributaries and Turbulence, The Rolling River, and The Delta. The results demonstrated that ASDBSN educated nurses are well socialized in the nursing profession and experience a high degree of job satisfaction and intent to stay in the profession.

Resilience and transition to practice in Direct Entry nursing graduates.

Resilience may be one factor that influences new graduates transition to practice. This pilot study looked at one cohort of Direct Entry Accelerated Master's in Nursing graduates and compared the relationship over time between their transition to practice experience and their resiliency. Seventeen of 21 graduates participated in surveys at graduation and then three, six and 12 months post-graduation. The survey consisted of four parts: Demographics, Educational/Professional Satisfaction Scale (2016), the Casey-Fink Graduate Nurse Experience Scale (2004), and the Wagnild & Young Resiliency Scale (1993). The results indicated that professional satisfaction fluctuates during the first year of practice. At 12 months post-graduation only 57% of the respondents felt their education prepared them for the reality of nursing practice. Resilience at 12 months post-graduation accounts for 79% of the variance in the Casey Fink scores at 12 months. Interventions to improve resilience in new nursing graduates may be one way to positively impact transition to practice.

Managing corneal foreign bodies in office-based general practice.

BACKGROUND: Patients with a corneal foreign body may first present to their general practitioner (GP). Safe and efficacious management of these presentations avoids sight-threatening and eye-threatening complications. Removal of a simple, superficial foreign body without a slit lamp is within The Royal Australian College of General Practitioners' (RACGP's) curriculum and scope of practice. Knowing the rele-vant procedural skills and indications for referral is equally important. OBJECTIVE: The objective of this article is to provide an evidence-based and expert-based guide to the management of corneal foreign bodies in the GP's office. DISCUSSION: History is key to identifying patient characteristics and mechanisms of ocular injury that are red flags for referral. Examination tech-niques and methods of superficial foreign body removal without a slit lamp are outlined, as well as the procedural threshold for referral to an ophthalmologist.

A Case Example of a Transitional Education Program for Internationally Educated Nurses from Mexico.

Internationally educated nurses migrating for work in other countries help address short and long-term staffing shortage issues. A transitional educational program was designed and implemented to prepare Mexican nurses with the competencies needed to work in any clinical setting in the United States. Through an intensive, full-time, 6-month transitional education program that included a living stipend during program participation, 30 out of 67 Mexican nurse candidates passed the NCLEX-RN, an English-language competency test, and were successfully placed in a hospital setting. Several salient lessons emerged from program implementation that have implications for transitions and capacity building among internationally educated nurses.

Improving the adoption of evidence-based practice through RN-to-BSN education.

BACKGROUND: Although enrollment in RN-to-BSN degree completion programs has grown profoundly, a dearth of literature exists regarding the impact of RN-to-BSN education and the adoption of evidence-based practice (EBP). This study examined the elements of RN-to-BSN education that improve the awareness and adoption for EBP. METHOD: A mixed methods meta-synthesis was conducted using qualitative, textual-narrative, and descriptive research studies. Data from six articles were analyzed, using standardized critical appraisal instruments. RESULTS: Two findings were identified. First, EBP skills for RN-to-BSN students are influenced by exposure to educational partnerships, contextual teaching and learning, and practice experiences. Second, barriers to adoption exist for RN-to-BSN students, which limit advances in nursing practice. CONCLUSION: A variety of contextual teaching and learning strategies can provide empowerment for RN-to-BSN students to adopt EBP in their practice. Forming partnerships in creating EBP experiences may set the stage for RN-to-BSN leadership opportunities in today's health care system.

An advanced practice nursing program for foreign medical doctors: a practical approach.

AIM: This article articulates lessons learned about an accelerated family nurse practitioner course offered to foreign medical doctors who also held baccalaureate nursing degrees (BSN). BACKGROUND: In the last decade, many physicians in the Philippines returned to school to obtain BSN degrees and licensure as registered nurses (referred to as nurse-medics) to emigrate to the United States in the hope of a better life. Once in the United States, many remain in nursing even though they prefer the practice of medicine. METHOD: This fast-track master's degree program began in fall 2006 at a university in the southwestern United States in collaboration with St. Jude College in the Philippines. By the end of this program (2010), 76 students had graduated. All who sat for the FNP national certification exam passed on the first attempt. RESULTS: Due to a decrease in qualified applicants, the program eventually closed, but a number of important lessons were learned. CONCLUSION: Nursing programs planning to undertake accelerated programs to transition medical doctors to nurse practitioners should consider they retake courses such as physical assessment, pharmacology and pathophysiology.

Developing confidence decreases guessing and increases competency.

Validating competency to meet accreditation and safety demands is a major challenge many organizations face. Traditional testing methods may only reflect guessing and may not capture the amount of misinformation nurses are using for critical decision making. Using a confidence-based learning methodology allows learners to correct misinformation and gain confidence and competency.

Simulation-based assessment and retraining for the anesthesiologist seeking reentry to clinical practice: a case series.

BACKGROUND: Established models for assessment and maintenance of competency in anesthesiology may not be adequate for anesthesiologists wishing to reenter practice. The authors describe a program developed in their institution incorporating simulator-based education, to help determine competency in licensed and previously licensed anesthesiologists before return to practice. METHODS: The authors have used simulation for assessment and retraining at their institution since 2002. Physicians evaluated by the authors' center undergo an adaptable 2-day simulation-based assessment conducted by two board-certified anesthesiologists. A minimum of three cases are presented on each day, with specific core competencies assessed, and participants complete a standard Clinical Anesthesia Year 3 level anesthesia knowledge test. Participants are debriefed extensively and retraining regimens are designed, where indicated, consisting of a combination of simulation and operating-room observership. RESULTS: Twenty anesthesiologists were referred to the authors' institution between 2002 and 2012. Fourteen participants (70%) were in active clinical practice 1 yr after participation in the authors' program, five (25%) were in supervised positions, and nine (45%) had resumed independent clinical practice. The reasons of participants not in practice were personal (1 participant) and medico-legal (3 participants); two participants were lost to follow-up. Two of 14 physicians, who were formally assessed in the authors' program, were deemed likely unfit for safe return to practice, irrespective of further training. These physicians were unavailable for contact 1 yr after assessment. CONCLUSION: Anesthesiologists seeking to return to active clinical status are a heterogeneous group. The simulated environment provides an effective means by which to assess baseline competency and also a way to retrain physicians.

Facilitating the career transition of second-career students into professional nursing.

This article describes the approaches used by the Second Careers and Nursing (SCAN) program to socialize second-career students into professional nursing. The pre-licensure phase of the program is guided by Schlossberg's transition theory of moving in, moving through, and moving out. Moving in involves setting expectations, from the admission interview to the two-day intensive orientation. Moving through entails imparting and instilling nursing's cultural content and values through the program's formal and informal curriculum. Moving out strengthens students' feelings of pride and their commitment to becoming professional nurses during a concentrated internship, NCLEX-RN preparation, and coaching for their first RN position. The article also reports on the socialization outcomes and lessons learned during the pre-licensure phase. Outcomes provide evidence that the SCAN program has successfully transitioned non-nursing college graduates into professional nursing by socializing them into the profession's knowledge, skills, and behaviors while they internalize nursing's values and goals.

Peer coaching to support writing development.

Learning to write well is a difficult but worthwhile effort, as nurses often need to communicate effectively through writing. A range of interventions has been used to promote effective writing by nursing students, but little outcome evidence, beyond student and faculty satisfaction, has been reported. A peer coaching assignment in a senior-level RN-to-BSN nursing complex care theory course required students to complete a scaffolded review of a peer's draft paper and provide constructive feedback to the peer. A masked and a nonmasked faculty rater (with interrater reliability of >0.99) scored the drafts and final papers. The mean scores of the participants' papers improved dramatically (M(change) = 14.24, SD(change) = 15.26, t [28] = 5.03, p = 0 .000, 95% CI(diff) [8.44, 20.05]), after peer feedback. Students' responses to the intervention included identification of learning outcomes and the benefits and challenges of providing and receiving peer feedback.

Rehabilitation of a cellist whose vibrato was affected by focal dystonia.

Focal dystonia can result in a variety of technical problems in the performing musician, most often affecting control of finger movement, and embouchure. Less common is the effect of focal dystonia on the vibrato of string players. The professional cellist in our study presented with difficulty controlling her vibrato, which fluctuated both in speed and amplitude, causing an inconsistency of sound. This study investigated whether instrumental retraining could alleviate her condition. We report the novel finding that instrumental retraining can significantly improve the symptoms of a dystonic vibrato in a cellist.

Impact of a pharmacist-directed educational program on the long-term knowledge and use of folic acid among college women: a 12-month follow-up study / Impacto de un programa educativo dirigido por farmacéutico sobre el conocimiento a largo plazo y uso del ácido fólico entre universitarias: estudio de seguimiento de 12 meses

Few studies have examined the impact of educational interventions on participants’ long-term knowledge and use of folic acid for prevention of neural tube defects (NTD). Objective: The objective of this pilot study was to evaluate changes in knowledge and behaviors in a sample of college women one year after such a program. Methods: Female students of a residential college campus voluntarily attended the event, which was advertised to the campus community as a women’s health seminar. Participants completed a multiplechoice test assessing knowledge of folic acid and NTD and frequency of multivitamin use before and immediately after a 30-minute oral presentation. Following 3 reminder messages sent via email or mail, knowledge and multivitamin use were reassessed 1-month and 12-months post-intervention. Results: Thirty-two college women participated in the educational intervention; 27 (84%) completed the 12-month post-test. At 12 months, statistically significant increases in knowledge from baseline remained for questions pertaining to food high in folic acid (p=0.023); completion of spinal column (p=0.011); and 2 questions on NTD prevention (p=0.044). Increases in knowledge regarding recommended daily allowance of folic acid (p=0.817) and difficulty in receiving adequate folic acid from diet alone (p=0.617) were not statistically significant from baseline. Regular multivitamin use (≥4 times per week) was not statistically significantly increased from baseline (p=0.592). Conclusion: Although it was encouraging that the women retained much of the information learned during the program, it appears that the changes in multivitamin use seen at 1-month were not sustained at 12-months. Further study with larger groups of college women is recommended (AU)

Pocos estudios han examinado el impacto de las intervenciones educativas sobre el conocimiento a largo plazo de los participantes y el uso de acido fólico para prevenir los defectos del tubo neural (DTN). Objetivo: El objetivo de este estudio piloto fue evaluar los cambios en conocimientos y comportamiento en una muestra de universitarias un año después de tal programa. Métodos: Mujeres estudiantes de una residencia universitaria del campus atendieron voluntariamente al evento, que se promocionó en la comunidad universitaria como un seminario de salud de la mujer. Los participantes completaron un examen de preguntas de elección múltiple que evaluaba el conocimiento del ácido fólico y de los DTN y el uso de multivitamínicos antes e inmediatamente después de una presentación oral de 30 minutos. Después, se utilizaron 3 mensajes de recuerdo, enviados por email o correo, para reevaluar 1 mes y 12 meses post-intervención. Resultados: 32 universitarias participaron en la intervención educativa; 27 (84%) completaron el post-test de 12 meses. A los 12 meses, persisten aumentos significativos del conocimiento inicial para las preguntas relativas a los alimentos ricos en ácido fólico (p=,023), compleción de la columna vertebral (p=0,011); y las 2 preguntas sobre prevención de los DTN (p=0,044). Los aumentos en conocimiento relativos a la ingesta diaria recomendada de ácido fólico (p=0,817) y la dificultades en recibir la cantidad adecuada de ácido fólico solo en la dieta (p=0,617) no fueron estadísticamente significativas respecto al inicio. El uso de multivitamínicos ((≥4 veces a la semana) no se aumentó significativamente desde el inicio (p=0,592). Conclusión: Aunque es esperanzador que las mujeres retenían mucha de la información aprendida durante el programa, parece que los cambios en el uso de multivitamínicos que se veían tras 1 mes, no se mantuvieron a los 12 meses. Se recomiendan estudios con grupos mayores de universitarias (AU)