Enhancing Student Engagement: Innovative Strategies for Intentional Learning

Aim

This paper presents four innovative teaching modalities conceptually designed and adherent to National Survey of Student Engagement (NSSE) indicators.

Antimicrobial susceptibility testing (AST): A review of changing trends,quality control guidelines,test accuracy,and recommendation for the testing of β-lactam drugs

The review that follows presents the changing trends in antimicrobial susceptibility testing observed from the author's clinical laboratory experience and the proficiency testing surveys of the College of American Pathologists (CAP). The CAP Microbiology Surveys show a clear trend toward standardized test methods of the National Committee for Clinical Laboratory Standard (NCCLS) and greater compliance with specified methods' technical steps. This has favorably inlfuenced the laboratory performance on proficiency challenges where a 3–5% improvement has been noted over the last 5 years for the disk tests (overall acceptable rate of 95.2% in 1981). A concurrent increase in dilution test use, mainly broth microdilution methods, has resulted in > 25% of larger hospital laboratories reporting results as MICs (overall acceptable or good performance = 98%). Automated systems use also continues to increase, with user performance being monitored at an acceptable level.Quality control frequency may be reduced to once weekly without compromising test accuracy or patient care, but only after adequate daily or concurrent QC performance has been documented. Most methods continue to have problems in testing enterococci, methicillin-resistant staphylococci, and the class-disk concept appears to be less applicable. Recommendations are made for the testing of the newer semisynthetic penicillins and cephalosporins based on their spectrum comparability and cross-resistance studies with bacteria possessing known susceptibility or resistance mechanisms. The concept of “spectrum-class” is introduced with peer drugs within classes.The general trends and quality of antimicrobial susceptibility tests seem outstanding and point toward continued excellent intra- and interlaboratory reproducibility at the national level, primarily due to the efforts of the inspection and accreditation agencies, CAP, CDC, and other concerned professional groups.     

Cefotaxime, cephalothin, and cephapirin: antimicrobial activity and synergy studies of cephalosporins with significant in vivo desacetyl metabolite concentrations

The desacetyl metabolites of cefotaxime, cephalothin, and cephapirin were 5-55% as active as the parent drug, depending upon the bacterial species tested. Synergy or partial synergy was demonstrated in 64% of 25 strains of Enterobacteriaceae and Staphylococcus aureus tested against cephalothin/desacetylcephalothin and cephapirin/desacetylcephapirin combinations. Some species variations were identified that influenced synergy rates, particularly among the S. aureus strains (for example, highest rates for cephapirin).     

Joint mobilization and static stretching for individuals with chronic ankle instability – A pilot study

Objective

To complete preliminary analysis regarding the effects joint mobilization timing during a 4-week calf stretching intervention on clinician-oriented and patient-oriented outcomes in individuals with chronic ankle instability (CAI). Additionally, a secondary objective was to examine the combined effect of joint mobilization and calf stretching.

Low dose intramuscular methadone for acute mild to moderate opioid withdrawal syndrome

Study objective

To assess the efficacy of 10 mg intramuscular (IM) methadone in patients with opioid withdrawal syndrome (OWS).

Norfloxacin (MK-0366, AM-715): In vitro activity and cross-resistance with other organic acids including quality control limits for disk diffusion testing

Norfloxacin is a new organic acid antimicrobic with an expanded spectrum that includes Staphylococcus spp, most Pseudomonas spp, Acinetobacter calcoaceticus ssp anitratus, some streptococci, as well as nearly all enteric bacilli. The drug appears to be bactericidal. Its expanded spectrum suggests that it should be tested separately by disk diffusion or other susceptibility testing methods. Tentative norfloxacin disk test quality control limits were derived from the results of a multi-laboratory study: Escherichia coli, 28–36 mm; S. aureus, 17–28 mm, and Pseudomonas aeruginosa, 22–29 mm.     

Spatial summation of pre-pain and pain in human teeth

The purpose of this work was to investigate the relation between the sensations of pain and 'pre-pain' evoked by stimulation of teeth in human subjects. Electrical pulses of progressively increasing amplitude, generated by a computer-controlled stimulator, were applied to 1 or 2 teeth, and the subjects responded by indicating the nature of the resulting sensation. Pre-pain and pain could be readily and rapidly distinguished by all 11 subjects (response latency about 0.4 sec). Both sensations had stable thresholds with relatively small variance (S.D. 10-15% of threshold value) for a given subject. Subjects characterized the stimuli as indifferent or unpleasant, localized, and brief. By using special stimulation strategies (termed 'optimal trajectories') for exciting 2 teeth simultaneously, spatial summation for pre-pain was demonstrated in most subjects and for pain in almost all subjects. Spatial summation of pre-pain resulted in pain rather than in more intense pre-pain. These results are consistent with both the dual modality (separate afferent fibers for pre-pain and pain) and the single modality hypotheses (single type of afferent fibers) of tooth pulp sensibility, but favor single modality innervation.     

Academic nursing leadership in a rural setting: Different game,same standards

The call for transformation of nursing education and practice continues to be a national priority. The American Association of Colleges of Nursing recommends enhanced partnerships between academic nursing and academic health centers to advance nursing and healthcare. For academic leaders in rural settings, the context of health and healthcare means that these partnerships are vastly different from academic health centers. The purpose of this article is to describe the context of nursing education and practice in regions that are predominantly rural. The challenges and opportunities for rural academic leaders as they respond to calls for transforming the education of the future nursing workforce are described from the perspective of resources, recruitment and retention of faculty, clinical education and faculty practice, scholarship, and fundraising. Meeting rural health workforce needs is a national imperative and a priority of academic nursing leaders in rural settings.     

A procedure for the kinetic colorimetric determination of serum cholinesterase activity

A choline oxidase-peroxidase coupled enzyme procedure is proposed for the determination of cholinesterase activity in human serum. This system is not only kinetic and colorimetric but is also relatively quick and simple to perform. The initial comparisons suggest that this method correlates well with a commonly used propionylthiocholine-dinitrobis-(nitro-benzoic acid) technique. Large amounts of bilirubin in the sample appear to have only minor deleterious effects on the assay. Since there are only two reagents that may be premixed, the procedure appears to be amenable to automation.The use of a mixture of sodium 2-hydroxy-3,5-dichlorobenzenesulfonate and 4-aminoantipyrene in the peroxidase catalyzed indicator reaction provides for a marked increase in sensitivity over previously reported 4-aminoantipyrene-phenol systems. This augmented sensitivity provides for a relatively large reagent to sample ratio. In addition, the reagents lend themselves toward lyophilization or ‘dry-fill’.     

Antimicrobial activity,beta-lactamase stability and beta-lactamase inhibition of cefotetan and other 7-alpha-methoxy beta-lactam antimicrobials

The antimicrobial activity of three 7-alpha-methoxy beta-lactams were compared to cefoperazone and ceftriaxone. All had a similar spectrum of activity against the $\text{Enterobacteriaceae}$, except cefoxitin. Cefotetan was only slightly less active than moxalactam against the $\text{Enterobacter}$ spp. Ceftriaxone was most effective on Neisserias, $\text{Haemophilus}$ spp, nonenterococcal $\text{Streptococcus}$ spp, and $\text{Acinetobacter}$ spp. Cefoperazone generally inhibited more pseudomonads while all of the “cephamycins” showed activity against $\text{Bacteroides fragilis}$ and $\text{B. thetaiotaomicron}$.Beta-lactamase hydrolysis studies of six substrates having pharmacologic serum half lives of ? 2 hrs were performed by bioassay and automated procedures. Excellent correlations were found between methods up to 24 hrs. A “lag-phase” was observed for several drug/enzyme combinations before initiation of significant substrate hydrolysis. The 7-alpha-methoxy betalactams were routinely more stable to the six representative enzymes (Richmond-Sykes types I–V) than other “stable” cephalosporins. Substrate hydrolysis rates resulting in > 50% drug loss in ?1 hr generally produced resistant in vitro test results. Cefotetan, cefoxitin, moxalactam, cefriaxone, and dicloxacillin were potent inhibitors of Type I (P99) beta-lactamases. Moxalactam demonstrated significant inhibition and affinity for the Type V enzyme while cefoperazone uniquely possesses affinity (so-called inhibition) for all tested beta-lactamases. Cefotetan appears to be a promising, beta-lactam compound with some in vitro characteristics comparable to the 1-oxa-beta-lactams and alpha-methoxyimino cephalosporins.     

Addressing future demands: Nursing students,elders, and pet birds: A student-initiated quality improvement project

The purpose of this quality improvement (QI) project was to promote the enthusiasm of baccalaureate nursing students in providing service to older adults by using the concept of service learning as a teaching strategy. An additional goal of the student-initiated QI project, which later also included graduate social work students, was to explore the impact of caring for a pet for older adults in an assisted living facility (ALF). After completing a student-elder team QI project, nursing students' journals yielded three themes: Improved Communication Skills with Elders, Becoming Interested in The Eden Alternative^® Principles, and Skills in Implementing and Evaluating Interprofessional Interventions. Elders' anecdotal comments and interviews yielded four themes: Improved Self Care, Decreased Anxiety, Sense of Purpose, and Sense of Belonging. These outcomes demonstrate ways to drive student interest in interdisciplinary gerontological care and to promote elders' well-being when transitioning to residential care.