BACKGROUNDLifelong learning is an important part of professionalism as nurses need to maintain competency and current knowledge for practice.
PURPOSEThe purpose of this study was to examine the ...relationship between baccalaureate nursing studentsʼ self-directed learning (SDL) abilities and lifelong learning orientation.
METHODSA quantitative, correlational research design was used. Students (n = 124) completed the Self-Directed Learning Inventory (SDLI) and the Jefferson Scale of Lifelong Learning–Health Professions Students (JeffSLL-HPS).
RESULTSThere was a significant, positive correlation between the SDLI total scores and the JeffSLL-HPS total scores (r = 0.64, P < .0001). There also were positive correlations between the JeffSLL-HPS total scores and 4 SDL domainsinterpersonal communication (r = 0.39, P < .0001), planning and implementing (r = 0.52, P < .0001), self-monitoring (r = 0.48, P < .0001), and learning motivation (r = 0. 63, P < .0001).
CONCLUSIONNursing faculty should implement teaching and learning strategies that foster SDL abilities to increase lifelong learning orientation in nursing students.
Summary
Background The safety of topical therapies for atopic dermatitis (AD), a common and morbid disease, has recently been the focus of increased scrutiny, adding confusion as how best to manage ...these patients.
Objectives The objective of these systematic reviews was to determine the safety of topical therapies for AD.
Methods Databases searched included: OVID Medline, Medline In‐Process and Other Non‐Indexed Citations, Embase, and the Cochrane Central Register of Controlled Trials. In addition to the articles identified by this search, investigators were also referred to a list of links (most recently updated 25 September 2005) to recent Food and Drug Administration (FDA) studies, reports and meetings regarding the topical calcineurin inhibitors for further potential references. Only fully published papers available in English and data obtained from FDA sites were included. Furthermore, the criteria for inclusion and exclusion for each systematic review were further evaluated at a meeting of all of the content and evidence‐based medicine experts participating in this process and alteration of the inclusion criteria was done at that time when it was felt necessary to avoid inclusion of lower‐quality data in the review. Qualitative review of the ed data was performed and reviewed at a meeting of all of the content and evidence‐based medicine experts.
Results While systemic exposure to these topical agents does occur, physiological changes appear to be uncommon and systemic complications rare and have only been found with use of topical corticosteroids.
Conclusions Based on the data that are available the overall safety of AD therapies appears to be good with the only documented systemic side‐effects of therapy those occasionally seen with use of topical corticosteroids.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Background Ulcerative colitis (UC) can be maintained in remission with 5‐aminosalicylic acid (5‐ASA) medications, but frequent non‐adherence by patients who are feeling well has been ...associated with more frequent flares of colitis.
Aim To perform a systematic review of the published literature and unpublished randomized clinical trials (RCTs) regarding the impact of non‐adherence with 5‐ASA medications on the incidence of UC flares and costs of care.
Methods A search of MEDLINE, EMBASE and the Cochrane databases was performed. Prospective studies of UC maintenance with 5‐ASAs in adults were selected if they included data on adherence and disease flares. Studies using insurance claims data to estimate the impact of non‐adherence on cost of care were included. Data from unpublished RCTs were obtained from the FDA with a request under the Freedom of Information Act.
Results The relative risk for flare in non‐adherent vs. adherent patients ranged from 3.65 to infinity. Data were obtained from six unpublished 5‐ASA RCTs, but none measured the impact of adherence on disease activity. The comorbidity‐adjusted annual costs of care in adherent patients were 12.5% less than in non‐adherent patients, despite increased medication expenditures.
Conclusions A substantial proportion of UC flares and medical costs of UC are attributable to 5‐ASA non‐adherence. As non‐adherence to 5‐ASA medications is common, cost‐effective strategies to improve adherence are needed. The impact of adherence on disease activity should be measured in RCTs of all inflammatory bowel disease treatments.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Magnetic resonance elastography (MRE) and transient elastography (TE) are noninvasive techniques for detection of liver fibrosis. Single-center studies have compared the diagnostic performance of MRE ...vs TE in patients with nonalcoholic fatty liver disease (NAFLD). We conducted a pooled analysis of individual participant data from published studies to compare the diagnostic performance of MRE vs TE for staging of liver fibrosis in patients with NAFLD, using liver biopsy as reference.
We performed a systematic search of publication databases, from 2005 through 2017. We identified 3 studies of adults with NAFLD who were assessed by MRE, TE, and liver biopsy. In a pooled analysis, we calculated the cluster-adjusted area under the curve (AUROC) of MRE and TE for the detection of each stage of fibrosis. AUROC comparisons between MRE and TE were performed using the Delong test.
Our pooled analysis included 230 participants with biopsy-proven NAFLD with mean age of 52.2±13.9 years and a body mass index of 31.9±7.5 kg/m2. The proportions of patients with fibrosis of stages 0, 1, 2, 3, and 4 were: 31.7%, 27.8%, 15.7%, 13.9%, and 10.9%, respectively. The AUROC of TE vs MRE for detection of fibrosis stages ≥1 was 0.82 (95% CI, 0.76-0.88) vs 0.87 (95% CI, 0.82-0.91) (P=.04); for stage≥ 2 was 0.87 (95% CI, 0.82-0.91) vs 0.92 (95% CI, 0.88-0.96) (P=.03); for stage ≥3 was 0.84 (95% CI, 0.78-0.90) vs 0.93 (95% CI, 0.89-0.96) (P=.001); for stage ≥ 4 was 0.84 (95% CI, 0.73-0.94) vs 0.94 (95% CI, 0.89-0.99) (P=.005).
In a pooled analysis of data from individual participants with biopsy-proven NAFLD, we found MRE to have a statistically significantly higher diagnostic accuracy than TE in detection of each stage of fibrosis. MRE and TE each have roles in detection of fibrosis in patients with NAFLD, depending upon the level of accuracy desired.
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