Category: Nevin Manimala

Comput Inform Nurs. 2023 May 1;41(5):300-308. doi: 10.1097/CIN.0000000000000920.

ABSTRACT

Although simulation laboratories are widely used in today’s nursing education programs, it is becoming more and more difficult to find adequate physical space, equipment, and instructors for laboratory practices in schools. With increasing access to quality technology, schools prefer Web-based education or virtual games as another way of learning through simulation laboratories. This study was carried out to evaluate the effect of digital game-supported teaching activity given to nursing students for the developmental care of infants in neonatal ICU on learning. This study is a quasi-experimental study with a control group. Within the scope of the study, the researchers, together with the technical team, developed a digital game in accordance with the purpose of the study. The study was conducted in a health sciences faculty, nursing department, between September 2019 and March 2020. Sixty-two students were included in the study, which were divided into two groups, with 31 students in the experimental group and 31 students in the control group. The study data were collected using a personal information tool and a developmental care information tool. Whereas the digital game learning method was used for the students in the experimental group, the traditional teaching method was used for the students in the control group. No significant difference has been found between the pretest knowledge scores of the students in the experimental and control groups (P > .05). A statistically significant difference has been found in the rates of giving correct answers between the groups in the posttest and retention test (P < .05). The students in the experimental group gave more correct answers in the posttest and retention test than the students in the control group. In line with these results, the learning method with digital games is effective in increasing the knowledge level of nursing undergraduate students. Therefore, it is recommended to integrate digital games into education.

PMID:37145853 | DOI:10.1097/CIN.0000000000000920

Eur J Dent Educ. 2023 May 5. doi: 10.1111/eje.12916. Online ahead of print.

ABSTRACT

INTRODUCTION: The development of early self-assessment skills and determining its correlation with academic performance could provide evidence to alter dental curricula. The aim of this retrospective study was to examine the relationships between students’ early self-assessment ability in waxing and three different evaluation methods (waxing assessment, written examinations, and tooth identification examination) in a dental anatomy course.

MATERIALS AND METHODS: The dental anatomy scores during the academic years of 2018-2019 and 2019-2020 from two cohorts of second-year pre-doctoral dental students at the Harvard School of Dental Medicine were analyzed. Regression analyses were completed to assess the relationship between all evaluation methods.

RESULTS: There was a statistically significant correlation between self-assessment ability and the waxing assessment but no significant correlation between self-assessment ability and the other evaluation methods.

CONCLUSION: Our results showed that the introduction of self-assessments in dental anatomy waxing was correlated with successful waxing skills. Furthermore, a relevant finding is that students who received higher classifications were also capable of doing better self-assessments. These findings provide evidence that impacts dental curricula.

PMID:37145843 | DOI:10.1111/eje.12916

Urol Pract. 2022 Nov;9(6):589-595. doi: 10.1097/UPJ.0000000000000345. Epub 2022 Nov 1.

ABSTRACT

INTRODUCTION: Patient and clinical factors are the most commonly identified variables associated with hospital readmission after radical cystectomy, but other factors may be important drivers of outcomes, such as hospital and physician characteristics. This study investigates the contribution of patient, physician, and hospital factors in hospital readmission after radical cystectomy.

METHODS: This was a retrospective review of the Surveillance, Epidemiology, and End Results-Medicare database focusing on bladder cancer patients who underwent radical cystectomy between 2007 and 2016. Medicare claims were identified using International Statistical Classification of Diseases-9/-10 or Healthcare Common Procedure Coding System codes from Medicare Provider Analysis and Review or National Claims History claims, from which the annual hospital/physician volumes were calculated and classified as low, medium, and high. A multivariable analysis was done for 90-day readmission as the outcome using a multilevel model to explore the association between readmission and characteristics of patient, hospital, and physician. Models with random intercepts were constructed to consider the variation from hospital and physician.

RESULTS: Of 3,530 patients, 1,291 (36.6%) were readmitted within 90 days of the index surgery. On multilevel multivariable analysis, factors significantly associated with readmission included continent urinary diversion (OR 1.55, 95% CI 1.21, 2.00), greater National Cancer Institute comorbidity index (2<4 vs 0-<2, OR 1.35, 95% CI 1.05, 1.75; 4+ vs 0-<2, OR 1.76, 95% CI 1.20, 2.58), American Joint Committee on Cancer stage (P = .04), and hospital region (P = .05). Neither hospital volume, physician volume, teaching hospital status, nor National Cancer Institute center designation was associated with hospital readmission. The main source of variation was determined to be the patient factors (95.89%), followed by the physician (1.43%), and then hospital (2.68%) factors.

CONCLUSIONS: Patient-specific factors are the most important in impacting the odds of readmission after radical cystectomy, while hospital and physician factors contribute minimally to this outcome.

PMID:37145810 | DOI:10.1097/UPJ.0000000000000345

Urol Pract. 2022 Nov;9(6):581-586. doi: 10.1097/UPJ.0000000000000336. Epub 2022 Nov 1.

ABSTRACT

INTRODUCTION: While urological complaints increase in aging populations and conditions commonly require management by multiple physician specialty types, exposure to formal urological education in United States medical schools is limited and has been decreasing over time. We aim to update the current status of urological education in the United States curriculum and delve further into the subject matter being taught and the type and timing of this education.

METHODS: An 11-question survey was developed to describe the current status of urological education. The survey was distributed using Survey Monkey to the American Urological Association’s medical student listserv in November 2021. Descriptive statistics were used to summarize survey findings.

RESULTS: Of 879 invitations sent, 173 responded (20%). Most (112/173, 65%) of respondents were in their fourth year. Only 4 (2%) reported that their school had a required clinical urology rotation. Kidney stones (98%) and urinary tract infections (100%) were the most frequent topics taught. The least exposure included infertility (20%), urological emergencies (19%), bladder drainage (17%), and erectile dysfunction (13%). Videos and case vignettes were the preferred learning modalities and the majority (84%) of respondents were familiar with the American Urological Association’s medical student curriculum material.

CONCLUSIONS: The majority of United States medical schools do not have a required clinical urology rotation and some core urological topics are not taught at all. Future incorporation of urological educational material through video and case vignette learning may be the best opportunity to provide exposure to clinical topics that will commonly be encountered regardless of chosen medical discipline.

PMID:37145808 | DOI:10.1097/UPJ.0000000000000336

Urol Pract. 2022 Nov;9(6):561-566. doi: 10.1097/UPJ.0000000000000339. Epub 2022 Nov 1.

ABSTRACT

INTRODUCTION: Clinical research can be expensive and time consuming due to high associated costs and/or duration of the study. We hypothesized that urine sample collection using online recruitment and engagement of research participants via social medial has the potential to reach a large population in a small timeframe, at a reasonable cost.

METHODS: We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants for urine sample collection. During this time, cost data were collected based on study associated costs from invoices and budget spreadsheets. The data were subsequently analyzed using descriptive statistics.

RESULTS: Each sample collection kit contained 3 urine cups, 1 for the disease sample and 2 for control samples. Out of the 3,576 (1,192 disease + 2,384 control) total sample cups mailed, 1,254 (695 control) samples were returned. Comparatively, the 2 clinical sites collected 305 samples. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $81.45 compared to $398.14 for clinic sample.

CONCLUSIONS: We conducted a nationwide, contactless, urine sample collection through online recruitment in the midst of the COVID-19 pandemic. Results were compared with the samples collected in the clinical setting. Online recruitment can be utilized to collect urine samples rapidly, efficiently, and at a cost per sample that was 20% of an in-person clinic, and without risk of COVID-19 exposure.

PMID:37145804 | DOI:10.1097/UPJ.0000000000000339

ASAIO J. 2023 May 5. doi: 10.1097/MAT.0000000000001950. Online ahead of print.

ABSTRACT

Refractory right ventricular failure has significant morbidity and mortality. Extracorporeal membrane oxygenation is indicated when medical interventions are deemed ineffective. However, it is still being determined if one configuration is better. We conducted a retrospective analysis of our institutional experience comparing the peripheral veno-pulmonary artery (V-PA) configuration versus the dual-lumen cannula with the tip in the pulmonary artery (C-PA). The analysis of a cohort of 24 patients (12 patients in each group). There was no difference in survival after hospital discharge (58.3% in the C-PA group compared to 41.7% in the V-PA group, p = 0.4). Among the C-PA group, there was a statistically significant shorter ICU length of stay (23.5 days [interquartile range {IQR} = 19-38.5] vs. 43 days [IQR = 30-50], p = 0.043) and duration of mechanical ventilation (7.5 days [IQR = 4.5-9.5] compared to (16.5 days [IQR = 9.5-22.5], p = 0.006) in the V-PA group. In the C-PA group, there were lower incidents of bleeding (33.33% vs. 83.33%, p =0.036) and combined ischemic events (0 vs. 41.67%, p = 0.037). In our single-center experience, the C-PA configuration might have a better outcome than the V-PA one. Further studies are needed to confirm our findings.

PMID:37145800 | DOI:10.1097/MAT.0000000000001950

Urol Pract. 2022 Sep;9(5):490. doi: 10.1097/UPJ.0000000000000311.02. Epub 2022 Jun 1.

NO ABSTRACT

PMID:37145766 | DOI:10.1097/UPJ.0000000000000311.02

Urol Pract. 2022 Sep;9(5):379-388. doi: 10.1097/UPJ.0000000000000327. Epub 2022 Jul 5.

ABSTRACT

INTRODUCTION: Chaperones are often employed during sensitive patient encounters and have been assumed to be mutually beneficial to the patient and provider. The aim of this study is to characterize patient preferences regarding the use of chaperones.

METHODS: Following Institutional Review Board Approval, a questionnaire designed to evaluate preferences regarding chaperone use from a patient perspective was distributed electronically through the ResearchMatch platform as well as to patients in an outpatient urology clinic. Descriptive statistics were used to assess responder demographics, clinical experiences and preferences. Multiple regression analysis was used to determine factors associated with a preference for having a chaperone present during health care visits.

RESULTS: A total of 913 individuals completed the survey. Over half (52.9%) reported they would not want a chaperone for any part of a health care visit. Although rectal and genital/pelvic examinations were considered sensitive by 76.3% and 85% of responders, respectively, only 25.4% and 15.7% preferred a chaperone during these encounters. Reasons for not wanting a chaperone included trust in the provider (80%) and comfort with examinations (70.4%). Male responders were less likely to report a preference for a chaperone (OR 0.28, 95% CI 0.19-0.39) or consider provider gender as a significant factor in preferring a chaperone (OR 0.28, 95% CI 0.09-0.66).

CONCLUSIONS: Preference regarding the use of a chaperone is primarily influenced by gender of both the patient and the provider. For sensitive examinations commonly performed in the field of urology, most individuals would not prefer a chaperone be present.

PMID:37145728 | DOI:10.1097/UPJ.0000000000000327

Urol Pract. 2022 Sep;9(5):474-480. doi: 10.1097/UPJ.0000000000000317. Epub 2022 Aug 22.

ABSTRACT

INTRODUCTION: COVID-19 has forever impacted health care in the U.S. Changes to health and hospital policies led to disruptions to both patient care and medical training. There is limited understanding of the impact on urology resident training across the U.S. Our aim was to examine trends in urological procedures, as captured by the Accreditation Council for Graduate Medical Education resident case logs, throughout the COVID-19 pandemic.

METHODS: Retrospective review of publicly available urology resident case logs between July 2015 and June 2021 was performed. Average case numbers were analyzed via linear regression with different models specifying different assumptions regarding the impact of COVID-19 on procedure in 2020 and onward. Statistical calculations utilized R (version 4.0.2).

RESULTS: Analysis favored models which assumed the impact of COVID-related disruptions were specific to 2019-2020. Analysis of procedures performed indicate an average upward trend of urology cases nationally. An average annual increase of 26 procedures between 2016 and 2021 was noted, except for 2020 which saw an average drop of approximately 67 cases. However, in 2021 case volume dramatically increased to the same rate as projected had there not been a disruption in 2020. Stratifying by category of urology procedure revealed evidence for variability between categories in the magnitude of the 2020 decrease.

CONCLUSIONS: Despite widespread pandemic-related disruptions in surgical care, urological volume has rebounded and increased, likely having minimal detriment to urological training over time. Urological care is essential and in high demand as evidenced by the uptick in volume across the U.S.

PMID:37145725 | DOI:10.1097/UPJ.0000000000000317

Urol Pract. 2022 Sep;9(5):481-490. doi: 10.1097/UPJ.0000000000000311. Epub 2022 Jun 1.

ABSTRACT

INTRODUCTION: There is a shortage in the number of urologists needed to satisfy the needs of an aging U.S.

POPULATION: The urologist shortage may have a pronounced impact on aging rural communities. Our objective was to describe the demographic trends and scope of practice of rural urologists using data from the American Urological Association Census.

METHODS: We conducted a retrospective analysis of American Urological Association Census survey data over a 5-year period (2016-2020), including all U.S.-based practicing urologists. Metropolitan (urban) and nonmetropolitan (rural) practice classifications were based on rural-urban commuting area codes for the primary practice location zip code. We conducted descriptive statistics of demographics, practice characteristics and specific rural-focused survey items.

RESULTS: In 2020, rural urologists were older (60.9 years, 95% CI 58.5-63.3 vs 54.6 years, 95% CI 54.0-55.1) and were in practice longer (25.4 years, 95% CI 23.2-27.5 vs 21.2 years, 95% CI 20.8-21.5) than urban counterparts. Since 2016, mean age and years in practice increased for rural urologists but remained stable for urban urologists, suggesting an influx of younger urologists to urban areas. Compared with urban urologists, rural urologists had significantly less fellowship training and more frequently worked in solo practice, multispecialty groups and private hospitals.

CONCLUSIONS: The urological workforce shortage will particularly impact rural communities and their access to urological care. We hope our findings will inform and empower policymakers to develop targeted interventions to expand the rural urologist workforce.

PMID:37145722 | DOI:10.1097/UPJ.0000000000000311