Making portfolios work in practice

BACKGROUND: A portfolio captures learning from experience, enables an assessor to measure student learning, acts as a tool for reflective thinking, illustrates critical analytical skills and evidence of self-directed learning and provides a collection of detailed evidence of a person's competence. AIMS: This paper reports data on how assessors and nursing students match learning outcomes and/or competencies to their practice and then reconstruct those experiences into the format required by the portfolio documentation. The data were gathered as part of a larger study to evaluate the use of portfolios in the assessment of learning and competence in England. METHODS: This three phase stakeholder evaluation was designed to gain the views of those involved in designing, implementing and using portfolios in nurse education. In phase 2, 122 students and 58 nurse teachers were interviewed about their perceptions of portfolio use, and a further 32 students and 26 assessors were interviewed after they had been observed taking part in an assessment process. Thematic data analysis was used. FINDINGS: Assessors and students underwent a complex process of deconstructing learning outcomes/competences to fit these to their practice. These then had to be reconstructed through the written medium to fit the structure of the portfolio. Confirmation that this met teachers' expectations was essential to allay feelings of insecurity. CONCLUSIONS: To achieve maximum benefit from the portfolio as a learning tool to link theory and practice, there needs to be a clear fit between the model of portfolio and the professional practice that is to be assessed. Outcomes and competences, as well as the type of evidence required to demonstrate their achievement, and integration of the whole experience should match the students' stage of professional and academic development. Over-complex approaches to practice assessment, particularly in the early stages of students' careers, can detract from clinical learning in favour of learning how to complete the portfolio successfully.     

The wound that nearly got away: a case presentation

Chronic cavity wounds are not commonly seen in pediatrics, and little literature is available on their management. A pediatric patient with juvenile dermatomyositis (JDMS) who had a chronic cavity surgical wound with an enterocutaneous fistula presented a nursing challenge. The patient had complex medical and surgical problems that greatly influenced her ability to heal. Nursing management of the wounds had to be innovative and flexible to adapt to these challenges. Factors affecting the patient's wound healing included JDMS; decreased mobility; persistently low serum magnesium, zinc and albumin; malnutrition; infection; and prolonged glucocorticosteroid therapy. Nursing management of her complex wounds included the following strategies: absorption of excessive exudate, wound support, debridement, wound irrigation, wound bagging, healing by secondary intention, and control of hypergranulation.     

Social and emotional loneliness in Korsakoff’s syndrome

Introduction: Loneliness is the subjective negative evaluation of social participation and isolation. Emotional loneliness reflects the absence of close relationships, and social loneliness the absence of a social network. Although loneliness is a growing problem in modern society, studies about loneliness in patients with Korsakoff’s syndrome (KS) in need of chronic care are currently missing.

Methods: Sixty-three KS patients in long-term care and their primary caregivers reported loneliness of the patients on the De Jong Gierveld Loneliness Scale.

Results: A majority of KS patients reliably reported to feel lonely on both a social and emotional level of loneliness. The caregiving professionals rated loneliness of the patients even higher. Patients that had stayed in the clinic for a longer time tended to report less social loneliness, while caregivers reported less emotional loneliness in those patients. The KS-specific neuropsychiatric symptom of confabulations and a lack of social visits had a negative impact on social loneliness as perceived by the caregivers.

Conclusion: Loneliness is a large problem in patients with KS that live in a long term care facility. Social loneliness can be positively influenced by creating possibilities to interact with other people, although the severity of the neuropsychiatric aspects of KS could compromise the presence of those interactions.     

In vitro parasiticidal effect of Nitazoxanide against Echinococcus multilocularis metacestodes

When humans serve as inadvertent intermediate hosts for Echinococcus multilocularis, disease (alveolar echinococcosis [AE]) may result from the expanding parasite metacestode in visceral organs, mostly in the liver. Benzimidazole carbamate derivatives such as mebendazole and albendazole are used for chemotherapeutic treatment of AE. However, these treatments are, in most cases, parasitistatic rather than parasiticidal. As treatment is discontinued, a recurrence of parasite growth has been observed in many AE patients with nonradical resections. The only curative treatment for AE is radical surgical resection of the parasite tissue and support by chemotherapy. As there is a need for new treatment options for AE, the in vitro efficacy of nitazoxanide (NTZ), a broad-spectrum drug used against intestinal parasites and bacteria, was investigated. We showed that in vitro treatment of E. multilocularis metacestodes with NTZ induced high levels of alkaline phosphatase activity in the medium. Concurrently, distinct morphological and ultrastructural alterations were detected. Most significantly, two distinct types of alterations were observed as soon as after 3 h of NTZ treatment. At first, the drug induced a peripheral output of membranous vesicles from the tegumental membrane into the laminated layer. Simultaneously, germinal layer-associated undifferentiated cells produced large vacuoles filled with lipid-like and often electron-dense membranous segments. Other alterations were observed at later time points, including vacuolization of the germinal layer, accumulation of lipid droplets, and lastly, loss of microtriches and separation of the laminated and germinal layers. The pattern of damage induced by NTZ was different from the alterations earlier observed in albendazole sulfoxide-treated vesicles. The nonviability of NTZ-treated metacestodes was confirmed through bioassay, i.e., inoculation of treated and untreated parasites into mice. These experiments demonstrate the in vitro parasiticidal effect of NTZ on E. multilocularis metacestodes.     

Assessing meaningful change in quality of life over time: a users' guide for clinicians

The objective of this article is to help clinicians interpret trial-based quality of life (QOL) changes over time. We address a series of questions and provide guidelines that are fundamental to assessing and interpreting change. The issues addressed are as follows: (1) What are the characteristics of the population for whom changes in QOL are reported? (2) Is the QOL questionnaire reliable, valid, and responsive to change? (3) Are the timing and frequency of assessments adequate? (4) Is the study adequately powered? (5) How are multiple QOL outcomes addressed in analyses? (6) How are multiple time points handled? (7) Can alternative explanations account for the observed change or lack of observed change (eg, handling of missing data, survival differences, and changes in patient's QOL perspective over time)? and (8) How is statistical significance translated into meaningful change? These guidelines will support clinicians in reviewing the clinical trial literature, which in turn can help them use the data in the treatment decision process.     

Abnormal Results of Newborn Screening for SCID After Azathioprine Exposure In Utero: Benefit of TPMT Genotyping in Both Mother and Child

Journal of Clinical Immunology -