Design of a nursing objective structured clinical examination of a first-year clinical practice program.

OBJECTIVE: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. METHOD: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. RESULTS: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. CONCLUSION: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

Induction of a polyubiquitin gene promoter by dehydration stresses in transformed rice cells.

The expression of the maize polyubiquitin gene promoter UBI1 in rice cells has been used to study the involvement of ubiquitin in cell protection responses to dehydration caused by osmotic, saline or freezing stress. The effect of these stresses on UBI1 activity was investigated by the use of stably transformed rice calli (UBI1:GUS), as well as by transient expression experiments performed with cell lines with high or low tolerance to each type of stress. The theoretical analysis of the UBI1 promoter shows several putative stress-regulated boxes that could account for the stress-related UBI1 induction pattern described in this work. We suggest that the study of the differential UBI1 promoter-driven expression in rice cell lines with different level of tolerance to stress might be useful to elucidate complex signal transduction pathways in response to dehydration stresses in monocots.

A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis.

BACKGROUND: The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. AIM: To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. METHOD: The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SAT-SPS), which was comprised of 27 items. The categories assigned to the items were 'incorrect or not performed' (0), 'acceptable' (1), and 'correct' (2). PARTICIPANTS: 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. RESULTS: Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named 'Nursing process', 'Communication skills', and 'Safe practice'. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. CONCLUSIONS: The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients. This tool has three main components: the nursing process, communication skills, and safety management.

A relationship between tolerance to dehydration of rice cell lines and ability for ABA synthesis under stress.

Plant dehydration is commonly caused by some adverse environmental conditions such as salinity, drought and freezing. As the plant hormone abscisic acid (ABA) is involved in responses to water stress, we studied its putative relationship with the degree of tolerance to these abiotic stresses. For this purpose we used cell lines that had been established from mature embryos of rice (Oryza sativa L, cvs. Bahia and Bomba), and selected by their high (L-T) or low (L-S) levels of tolerance to each type of stress. Tolerance of rice calli to either osmotic, saline, or freezing stress was generally improved by a previous treatment with ABA. This ABA effect was evident in those callus lines with low tolerance (L-S), as their ability to recover from stress increased up to three fold. Independent of the cultivar used, there were no significant differences in the endogenous ABA contents between untreated L-T and L-S lines. However, upon stress, the increase in endogenous ABA was higher in L-T than in L-S lines. These results, together with those obtained by using Fluridone, an inhibitor of ABA synthesis, show that differences in the level of cell tolerance to osmotic, saline and freezing stress are related to their different capacity of ABA synthesis under stress conditions.

Design of a nursing objective structured clinical examination of a first-year clinical practice program / Projeto de um exame clínico estruturado objetivo de enfermagem de um programa de prática clínica do primeiro ano / Diseño de una prueba de evaluación clínica objetiva estructurada de cuidados de enfermería del primer curso de prácticas clínicas

ABSTRACT Objective: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. Method: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. Results: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. Conclusion: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program.

RESUMO Objetivo: O objetivo do presente estudo foi elaborar um exame clínico estruturado de objetivos de enfermagem com conteúdo válido, participando de um programa de prática clínica de enfermagem do primeiro ano. Método: O exame foi elaborado seguindo um procedimento baseado no consenso de especialistas que compreendeu três fases: seleção das atividades nas quais os alunos deveriam ser competentes de acordo com os resultados de aprendizagem do curso, desenho do caso clínico e integração do quadro clínico casos projetados para as estações do teste. Resultados: Das 44 pesquisas submetidas para a concepção das estações, 37 foram respondidas, das quais 31 respondentes atenderam aos critérios de inclusão do painel de especialistas. As atividades nas quais os especialistas alcançaram maior grau de consenso foram: avaliação física básica e monitoramento dos sinais vitais, avaliação da higiene e do estado da pele, capacidade de desenvolver planos de cuidados, gestão dos princípios de segurança na administração de medicamentos e administração de medicamentos orais. Com base nas atividades selecionadas, os especialistas desenvolveram 20 casos clínicos, a partir dos quais foi elaborado um exame clínico estruturado objetivo de enfermagem em quatro estações. Conclusão: A metodologia estruturada baseada na concepção de especialistas permitiu a concepção de um exame clínico estruturado objetivo válido e de conteúdo adequado para a avaliação dos resultados de aprendizagem alcançados pelos alunos que frequentam um programa de prática clínica.

RESUMEN Objetivo: El objetivo de este estudio fue diseñar una Evaluación Clínica Objetiva Estructurada con validez de contenido para evaluar el nivel de competencias de estudiantes de primer curso de formación practico-clínica enfermera. Método: Se diseñó la prueba siguiendo un procedimiento basado en consenso de expertos con tres fases: selección de las actividades en la que los alumnos debían ser competentes en base a los resultados de aprendizaje de la asignatura, diseño de casos clínicos, e integración de los casos clínicos diseñados en las estaciones de la prueba. Resultados: Las actividades que alcanzaron mayor consenso por parte de los expertos fueron: valoración física básica y monitorización de signos vitales, valoración de la higiene y estado de la piel, capacidad para elaborar planes de cuidados, manejo de los principios de seguridad en la administración de medicación y administración de medicación oral. En base a las actividades seleccionadas, los expertos elaboraron 20 casos clínicos, a partir de los cuales se diseñó una evaluación clínica objetiva estructurada de cuidados de enfermería formada por cuatro estaciones. Conclusión: La metodología estructurada basada en el diseño de expertos permitió el diseño de una evaluación clínica objetiva estructurada adecuada para evaluar los resultados de aprendizaje alcanzados por los estudiantes de primer curso de formación práctico-clínica.

Is ABA involved in tolerance responses to salinity by affecting cytoplasm ion homeostasis in rice cell lines?

The ability of plant cells to maintain cytoplasm ion homeostasis under saline stress is among the main mechanisms involved in salt tolerance. To cope with excess Na(+), cells extrude it from the cytoplasm, which requires expenditure of metabolic energy, provided by H(+) gradients generated by membrane-bound H(+)-pumps. ABA is well-known to be involved in physiological processes elicited or enhanced by stresses causing cell dehydration. In this work we studied the possible implication of this plant hormone in the control of salt-induced cellular mechanisms conducting to Na(+) extrusion from the cytoplasm. We used rice (Oryza sativa L.) cell lines selected for their different tolerance to salinity to measure the response to ABA of H(+)-pumps and Na(+)/H(+)-antiporters associated to the plasma membrane and the tonoplast. Our results show that ABA generally enhances H(+)-pumping under salt stress but not under control conditions. This effect occurs to a higher extent across the tonoplast in the more tolerant lines (L-T). Na(+)/H(+) antiport activity is practically undetectable in calli under control conditions, pre-treated or not with ABA, but shows a strong activation under salinity across the tonoplast, particularly in L-T lines (cv Bahia) and also across de plasma membrane in cv Bomba. In these lines, prior treatments with ABA tend to reduce the NaCl enhanced activity of both antiporters. Overall, under saline conditions ABA seems to affect synergistically H(+) pumping and antagonistically Na(+) extrusion. A complex network of positive and negative regulatory signals seems involved in restoring ion cell homeostasis under salt stress.

Differential salinity-induced variations in the activity of H⁺-pumps and Na⁺/H⁺ antiporters that are involved in cytoplasm ion homeostasis as a function of genotype and tolerance level in rice cell lines.

The characterisation of cellular responses to salinity in staple crops is necessary for the reliable identification of physiological markers of salinity tolerance. Under saline conditions, variations in proton gradients that are generated by membrane-bound H⁺ pumps are crucial for maintaining cytoplasm homeostasis. We examined short (15 h) and longer term effects (4 days) of NaCl stress on the H⁺ pumping activities that are associated with the plasma membrane (P-ATPase) and the tonoplast (V-ATPase and V-PPase) in rice (Oryza sativa L.) callus lines that displayed different levels of NaCl tolerance and were established from two japonica rice cultivars. The applied stress conditions were based on those that were used in the induction of a stress-responsive polyubiquitin gene promoter (UBI1) in transgenic rice calli. The most remarkable effect of NaCl stress on H⁺ pumping was the rapid activation of tonoplast-bound pumps; this was particularly observed in cv. Bomba, in which the response of the P-ATPase was slower and showed a higher level of activity after 4 days of stress. The responses were cultivar-dependent; however, in general, a stronger activation occurred in the lines that had a higher tolerance (L-T) than in the less-tolerant (L-S) lines. Substrate hydrolysis was less affected than H⁺ pumping, and it yielded higher H⁺/substrate coupling ratios, which is indicative of an enhanced H⁺ pumping efficiency under saline conditions. The Na⁺/H⁺ antiport activity was generally limited to salt-stressed calli, and higher values and stronger activation of the tonoplast antiporter were observed in the L-T lines than in the L-S lines. The results that were obtained with the NaCl-stressed transgenic lines confirmed the close relationship between metabolic activity, H⁺ pumping and the induction of Na⁺/H⁺ exchange activities.

Uptake of an endocytic marker by rice cells: variations related to osmotic and saline stress.

Saline and osmotic stress are the main abiotic factors limiting the productivity of rice and other crop plants. Although both coincide in generating water deficit and affect many aspects of plant growth and development similarly, some effects of salinity are distinctively related to the ionic component of salt stress. At the cellular level, dessication tolerance is largely dependent on the cell's ability for osmotic adjustment. Here, we have studied the effects of saline and osmotic stress on endocytosis by rice cells, to investigate the common and distinctive effects of saline-generated stress and osmotically generated stress, and the possible involvement of endocytosis in tolerance mechanisms. For this purpose, we have used rice cell lines with different levels of tolerance and biotinylated bovine serum albumin (bBSA) as an endocytic marker, which in our previous experiments has been shown to enter rice cells by a process with the characteristics of receptor-mediated endocytosis. Our results indicate that the pattern of uptake is common to both types of stress. Thus, when rice cells were subjected to saline or osmotic stress there was an initial dose-dependent inhibition of uptake. However, after more extended stress periods, there was an activation of uptake in the stressed cells. This late activation appears mainly related to the inhibition of growth commonly caused by the different stress agents used in this study. When using cell lines with different degrees of tolerance, the level of uptake activation varied as a function of the type of stress. Thus, under osmotic stress, a higher stress tolerance was directly related to a higher bBSA uptake, while the opposite occurred under saline stress. The possible role of endocytosis in the cellular responses to osmotic and saline stress is discussed.