Assessment of recent graduates preparedness for entry into practice.

To date no studies have been conducted to assess the preparedness of CRNA graduates for entry into practice by asking graduates and their respective employers to assess specific competencies. The purpose of this study was to assess recent graduates' preparation and performance. It was hypothesized recent graduates are prepared for entry into nurse anesthesia practice. This study was conducted between August 2011 and February 2012. An online survey tool was used to rate graduates' preparedness to perform 17 professional competencies. Surveys were distributed to 2349 CRNAs who graduated in 2009 and 2,663 employers who hired recent graduates. A power of 90% for employers and 85% for graduates was obtained (P = .05). Analysis of a sample size of 148 matched graduate-employer pairs provided 88% power. Overall, 98% of the graduates and 97% of the employers indicated graduates were prepared for practice. Of the 1,407 graduates assessed by employers, 1,343 (96%) would be hired again. Competencies identified as opportunities to enhance include administration of peripheral nerve blocks, insertion of central lines, insertion of pulmonary artery (PA) catheters, and chronic pain management techniques. The majority of employers rated these competencies as not applicable in their practice setting. Results suggest recent graduates are prepared and perform the competencies for entry into practice. While graduates and employers identified opportunities to enhance preparation it may not be sufficient to simply improve education without changing CRNA practice expectations.

Glomangioma.

A 22-year-old man presented with a 9-year history of multiple blue nodules on the medial aspect of his right arm. A biopsy specimen showed a cystic space with a cuboidal cellular lining that stained positive for α-smooth-muscle actin; these findings were consistent with multiple glomangiomas. We review the clinical and histopathologic characteristics of this rare entity.

Minimizing and Reporting Momentary Time-Sampling Measurement Error in Single-Case Research.

Research indicates that momentary time sampling (MTS) is often the best interval-measurement system when observing duration of behavior. Several recent studies recommended considering mean duration of target behavior, as well as durations of measurement intervals and observation sessions, to minimize measurement error in MTS. This report describes the steps we used to minimize measurement error in a single-case design research study. Further, we detail our methods for monitoring and reporting MTS measurement error across conditions by intermittently collecting and analyzing duration per occurrence measurements.

Symptom assessment of patients with chronic obstructive pulmonary disease.

The primary purpose of this secondary data analysis was to evaluate the efficacy and suitability of the Memorial Symptom Assessment Scale (MSAS) for use with patients with severe chronic obstructive pulmonary disease (COPD). Symptoms experienced by patients with severe COPD were assessed in the original investigation using the 32-item MSAS. The sample consisted of 72 individuals with COPD ranging in age from 36 to 79 years. To increase its efficiency for use with severely ill COPD patients, the original MSAS was shortened to include the 19 most frequently reported symptoms. Reliability of the revised tool remained high (Cronbach's alpha = .86). Content and convergent validity of the revised tool were also established. The revised MSAS appears to be an appropriate measure of the multidimensional, multisymptom experience of patients with severe COPD.

Seeking self-evaluative feedback: the interactive role of global self-esteem and specific self-views.

People who verify a negative self-view expose themselves to criticism and rejection. Because people with low global self-esteem are hurt more by negative feedback than are people with high global self-esteem, the authors predicted that they would be less apt to verify a negative self-view in a more specific domain. Three investigations found support for this hypothesis. In all 3 investigations, high self-esteem participants sought (or tended to seek) self-verifying feedback, even if it was negative, but low self-esteem participants sought (or tended to seek) positive feedback, even if it was nonself-verifying. These findings show that low self-esteem people are especially concerned with self-protection and that global self-esteem and specific self-views interact to guide people's responses to self-evaluative feedback.

Measurement of cis and trans isomers of vitamin K1 in rat tissues by liquid chromatography with a C30 column.

The purpose of this study was to validate a method for measuring vitamin K isomers in rat tissues by liquid chromatography (LC) with fluorescence detection after simple solvent extraction. This method uses separation on a C30 column, followed by zinc reduction and fluorescence measurement (243 nm, excitation; 430 nm, emission) to detect and quantitate vitamin K isomers. We were able to separate cis- and trans-vitamin K1 in methylene chloride extracts of homogenized rat livers and in hexane extracts of rat plasma. Tissue extracts were evaporated and rediluted with tetrahydrofuran-methanol (1 + 1) or methanol before being injected under isocratic conditions onto the LC column. Liver tissue of Fischer 344 rats fed a vitamin K1-containing diet ad libitum contained approximately 20 and 60 ng/g cis- and trans-vitamin K1, respectively. Mean recoveries of vitamin K1 isomers from spiked liver were 92 +/- 11% for cis-vitamin K1 and 106 +/- 5% for trans-vitamin K1. We recovered 96 +/- 8% of trans-vitamin K1 added at 1, 3, and 6 ng/mL to plasma (containing an endogenous level of 4 ng/g) from the same rats; we recovered 112 +/- 5% when trans-vitamin K1 was added to human serum (National Institute of Standards and Technology Standard Reference Material 968C). This direct method shows significant potential for the selective measurement of vitamin K1 isomers in tissues.

Determination of vitamin K1 isomers in foods by liquid chromatography with C30 bonded-phase column.

Vitamin K1 was determined in a variety of foods by using reversed-phase liquid chromatography with a C30 column followed by post-column reduction to the fluorescent hydroquinone derivatives. Lipids were removed by lipase digestion, followed by single extraction into hydrocarbon, and the protocol was extended to selected natural and processed foods. Biologically active trans- and inactive ci-vitamin K1 isomers were measured individually to evaluate the true nutritional status of the products. Method performance parameters confirmed the validity of the technique. The use of the triacontyl-bonded C30 phase for selective phylloquinone isomer measurement extends previously validated AOAC Method 999.15 for vitamin K1 in milk and infant formula to a wider range of foods important in the human diet. The cis-vitamin K1 isomer contributes up to about 15% of total phylloquinone in certain foods.

Pathologic uterine torsion associated with placental abruption, maternal shock, and intrauterine fetal demise.

Torsion of the uterus is a rare obstetric complication. This report describes a 270-degree uterine torsion associated with placental abruption, maternal shock, and fetal demise. At laparotomy, the uterus and ovaries were necrotic. This patient presented in a manner typically managed by labor induction, thus delaying her diagnosis of uterine torsion.

Emotional responses to changing feedback: is it better to have won and lost than never to have won at all?

Two experiments investigated how self-esteem guides people's emotional responses to changing evaluative feedback. In both experiments, participants received an initial evaluation (either positive or negative) followed by a second evaluation (either positive or negative). Emotional reactions to the second evaluation were then assessed. High self-esteem participants found feedback that was consistently negative to be most distressing, whereas low self-esteem participants were most disturbed by feedback that changed from positive to negative. The theoretical and practical implications of the findings are discussed.